Provider Demographics
NPI:1689111817
Name:GRASSMAN, CHRISTINE (NP)
Entity Type:Individual
Prefix:
First Name:CHRISTINE
Middle Name:
Last Name:GRASSMAN
Suffix:
Gender:F
Credentials:NP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 3
Mailing Address - Street 2:
Mailing Address - City:TOMBSTONE
Mailing Address - State:AZ
Mailing Address - Zip Code:85638-0003
Mailing Address - Country:US
Mailing Address - Phone:520-266-2293
Mailing Address - Fax:
Practice Address - Street 1:155 CALLE PORTAL STE 300
Practice Address - Street 2:
Practice Address - City:SIERRA VISTA
Practice Address - State:AZ
Practice Address - Zip Code:85635-2900
Practice Address - Country:US
Practice Address - Phone:520-459-3011
Practice Address - Fax:520-364-4261
Is Sole Proprietor?:No
Enumeration Date:2017-01-25
Last Update Date:2023-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZAP8680363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZMG4111251OtherDEA