Provider Demographics
NPI:1720592694
Name:MESICH, CHRISTINE (LICENCED MIDWIFE)
Entity Type:Individual
Prefix:
First Name:CHRISTINE
Middle Name:
Last Name:MESICH
Suffix:
Gender:F
Credentials:LICENCED MIDWIFE
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2900 FOREST MEADOW DR
Mailing Address - Street 2:
Mailing Address - City:ROUND ROCK
Mailing Address - State:TX
Mailing Address - Zip Code:78665-5612
Mailing Address - Country:US
Mailing Address - Phone:512-673-8774
Mailing Address - Fax:
Practice Address - Street 1:4100 DUVAL RD STE 101
Practice Address - Street 2:
Practice Address - City:AUSTIN
Practice Address - State:TX
Practice Address - Zip Code:78759-3550
Practice Address - Country:US
Practice Address - Phone:512-346-3224
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2017-11-29
Last Update Date:2018-03-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX99315176B00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes176B00000XOther Service ProvidersMidwifeGroup - Single Specialty