Provider Demographics
NPI:1659042687
Name:CHRISTIAN, OCTAVIA (RN)
Entity Type:Individual
Prefix:
First Name:OCTAVIA
Middle Name:
Last Name:CHRISTIAN
Suffix:
Gender:F
Credentials:RN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:69 DAMSEN RD
Mailing Address - Street 2:
Mailing Address - City:ROCHESTER
Mailing Address - State:NY
Mailing Address - Zip Code:14612-3637
Mailing Address - Country:US
Mailing Address - Phone:585-485-8934
Mailing Address - Fax:
Practice Address - Street 1:69 DAMSEN RD
Practice Address - Street 2:
Practice Address - City:ROCHESTER
Practice Address - State:NY
Practice Address - Zip Code:14612-3637
Practice Address - Country:US
Practice Address - Phone:585-485-8934
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-09-21
Last Update Date:2021-09-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY786365163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse