Provider Demographics
NPI:1821349713
Name:KING, CHRISTINE (LPN, CNA)
Entity Type:Individual
Prefix:
First Name:CHRISTINE
Middle Name:
Last Name:KING
Suffix:
Gender:F
Credentials:LPN, CNA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:136 CEDAR ST
Mailing Address - Street 2:
Mailing Address - City:KINGSTON
Mailing Address - State:NY
Mailing Address - Zip Code:12401-4934
Mailing Address - Country:US
Mailing Address - Phone:518-821-9092
Mailing Address - Fax:
Practice Address - Street 1:136 CEDAR ST
Practice Address - Street 2:
Practice Address - City:KINGSTON
Practice Address - State:NY
Practice Address - Zip Code:12401-4934
Practice Address - Country:US
Practice Address - Phone:518-821-9092
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-10-02
Last Update Date:2016-10-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY307743164W00000X
376K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse
No376K00000XNursing Service Related ProvidersNurse's Aide
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY0350478Medicaid