Provider Demographics
NPI:1972274025
Name:MOCKENSTURM, CHRISTINE KAY
Entity Type:Individual
Prefix:
First Name:CHRISTINE
Middle Name:KAY
Last Name:MOCKENSTURM
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:11740 SUGAR RIDGE RD
Mailing Address - Street 2:
Mailing Address - City:BOWLING GREEN
Mailing Address - State:OH
Mailing Address - Zip Code:43402-9611
Mailing Address - Country:US
Mailing Address - Phone:419-376-9124
Mailing Address - Fax:
Practice Address - Street 1:11740 SUGAR RIDGE RD
Practice Address - Street 2:
Practice Address - City:BOWLING GREEN
Practice Address - State:OH
Practice Address - Zip Code:43402-9611
Practice Address - Country:US
Practice Address - Phone:419-376-9124
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-09-27
Last Update Date:2021-09-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes374U00000XNursing Service Related ProvidersHome Health Aide
No172A00000XOther Service ProvidersDriver