Provider Demographics
NPI:1952072381
Name:CHRISTOPHER, MARLA (LPN)
Entity Type:Individual
Prefix:
First Name:MARLA
Middle Name:
Last Name:CHRISTOPHER
Suffix:
Gender:F
Credentials:LPN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5215 LAKEVIEW DR
Mailing Address - Street 2:
Mailing Address - City:CLEAR LAKE
Mailing Address - State:IA
Mailing Address - Zip Code:50428-8630
Mailing Address - Country:US
Mailing Address - Phone:151-568-9686
Mailing Address - Fax:
Practice Address - Street 1:1907 US HIGHWAY 18 E
Practice Address - Street 2:
Practice Address - City:CLEAR LAKE
Practice Address - State:IA
Practice Address - Zip Code:50428-2004
Practice Address - Country:US
Practice Address - Phone:641-357-5271
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-09-24
Last Update Date:2021-09-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IAPO9905164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse