Provider Demographics
NPI:1629340161
Name:PEREZ, CHRISTINA ELAINE (LPN)
Entity Type:Individual
Prefix:MISS
First Name:CHRISTINA
Middle Name:ELAINE
Last Name:PEREZ
Suffix:
Gender:F
Credentials:LPN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1107 ABBOTS GREEN CIR
Mailing Address - Street 2:
Mailing Address - City:COLUMBUS
Mailing Address - State:OH
Mailing Address - Zip Code:43204-4317
Mailing Address - Country:US
Mailing Address - Phone:614-584-6335
Mailing Address - Fax:
Practice Address - Street 1:1107 ABBOTS GREEN CIR
Practice Address - Street 2:
Practice Address - City:COLUMBUS
Practice Address - State:OH
Practice Address - Zip Code:43204-4317
Practice Address - Country:US
Practice Address - Phone:614-584-6335
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-01-30
Last Update Date:2012-01-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHPN115138 M-IV164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse