Provider Demographics
NPI:1891756714
Name:PEARSON, CHRISTINA IRENE (CRNA)
Entity Type:Individual
Prefix:
First Name:CHRISTINA
Middle Name:IRENE
Last Name:PEARSON
Suffix:
Gender:F
Credentials:CRNA
Other - Prefix:
Other - First Name:CHRISTINA
Other - Middle Name:IRENE
Other - Last Name:BENSON
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:CRNA
Mailing Address - Street 1:PO BOX 6907
Mailing Address - Street 2:
Mailing Address - City:DOTHAN
Mailing Address - State:AL
Mailing Address - Zip Code:36302
Mailing Address - Country:US
Mailing Address - Phone:334-793-5000
Mailing Address - Fax:334-615-8419
Practice Address - Street 1:4370 W MAIN STREET
Practice Address - Street 2:
Practice Address - City:DOTHAN
Practice Address - State:AL
Practice Address - Zip Code:36305
Practice Address - Country:US
Practice Address - Phone:334-793-5000
Practice Address - Fax:334-615-8419
Is Sole Proprietor?:No
Enumeration Date:2006-03-30
Last Update Date:2009-04-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL1040232367500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367500000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Anesthetist, Certified Registered
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL034489300Medicaid
AL051515688Medicaid
P00122072OtherRR MEDICARE
GA000519142AMedicaid
MS06271701Medicaid
LA1771341Medicaid
AL51515688OtherBLUE CROSS BLUE SHIELD
AL51515688OtherBLUE CROSS BLUE SHIELD
LA1771341Medicaid