Provider Demographics
NPI:1811360589
Name:CRIDDLE, CHRISTINA (RN)
Entity Type:Individual
Prefix:MRS
First Name:CHRISTINA
Middle Name:
Last Name:CRIDDLE
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 1:111 CHURCH ST STE 118A
Mailing Address - Street 2:
Mailing Address - City:FERGUSON
Mailing Address - State:MO
Mailing Address - Zip Code:63135-2430
Mailing Address - Country:US
Mailing Address - Phone:314-455-4444
Mailing Address - Fax:314-455-4444
Practice Address - Street 1:111 CHURCH ST STE 118A
Practice Address - Street 2:
Practice Address - City:FERGUSON
Practice Address - State:MO
Practice Address - Zip Code:63135-2430
Practice Address - Country:US
Practice Address - Phone:314-455-4444
Practice Address - Fax:314-455-4444
Is Sole Proprietor?:Yes
Enumeration Date:2015-11-03
Last Update Date:2023-11-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO2010003391163W00000X, 163WH0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse
No163WH0200XNursing Service ProvidersRegistered NurseHome Health