Provider Demographics
NPI:1811023583
Name:HASKELL, CHRISTINE L (LPN-SFA)
Entity Type:Individual
Prefix:MRS
First Name:CHRISTINE
Middle Name:L
Last Name:HASKELL
Suffix:
Gender:F
Credentials:LPN-SFA
Other - Prefix:
Other - First Name:CHRIS
Other - Middle Name:
Other - Last Name:HASKELL
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:LPN-SFA
Mailing Address - Street 1:PO BOX 156
Mailing Address - Street 2:
Mailing Address - City:MONTICELLO
Mailing Address - State:UT
Mailing Address - Zip Code:84535
Mailing Address - Country:US
Mailing Address - Phone:801-380-5020
Mailing Address - Fax:
Practice Address - Street 1:14981 NATIONAL AVE
Practice Address - Street 2:
Practice Address - City:LOS GATOS
Practice Address - State:CA
Practice Address - Zip Code:95032-2600
Practice Address - Country:US
Practice Address - Phone:801-380-5020
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-02-26
Last Update Date:2017-08-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAVN205839164X00000X
UT263622-3101164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse
No164X00000XNursing Service ProvidersLicensed Vocational Nurse