Provider Demographics
NPI:1689878696
Name:BLACK WISSINGER, CHRISTIE RAE (RN)
Entity Type:Individual
Prefix:MRS
First Name:CHRISTIE
Middle Name:RAE
Last Name:BLACK WISSINGER
Suffix:
Gender:F
Credentials:RN
Other - Prefix:
Other - First Name:CHRISTIE
Other - Middle Name:RAE
Other - Last Name:BLACK
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:RN
Mailing Address - Street 1:8645 E CHIMNEY SPRING DR
Mailing Address - Street 2:
Mailing Address - City:TUCSON
Mailing Address - State:AZ
Mailing Address - Zip Code:85747-5646
Mailing Address - Country:US
Mailing Address - Phone:520-574-2120
Mailing Address - Fax:520-225-4001
Practice Address - Street 1:1010 E 10TH ST
Practice Address - Street 2:
Practice Address - City:TUCSON
Practice Address - State:AZ
Practice Address - Zip Code:85719-5813
Practice Address - Country:US
Practice Address - Phone:520-225-4123
Practice Address - Fax:520-225-4001
Is Sole Proprietor?:No
Enumeration Date:2007-06-13
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZRN143669163WS0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WS0200XNursing Service ProvidersRegistered NurseSchool