Provider Demographics
NPI:1982841284
Name:FERNANDEZ, CHRISTINE LYNETTE (LMP)
Entity Type:Individual
Prefix:
First Name:CHRISTINE
Middle Name:LYNETTE
Last Name:FERNANDEZ
Suffix:
Gender:F
Credentials:LMP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:702 S HILL PARK DR
Mailing Address - Street 2:SUITE 101
Mailing Address - City:PUYALLUP
Mailing Address - State:WA
Mailing Address - Zip Code:98373-1426
Mailing Address - Country:US
Mailing Address - Phone:253-604-4953
Mailing Address - Fax:253-604-4956
Practice Address - Street 1:702 S HILL PARK DR
Practice Address - Street 2:SUITE 101
Practice Address - City:PUYALLUP
Practice Address - State:WA
Practice Address - Zip Code:98373-1426
Practice Address - Country:US
Practice Address - Phone:253-604-4953
Practice Address - Fax:253-604-4956
Is Sole Proprietor?:Yes
Enumeration Date:2009-01-08
Last Update Date:2010-10-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAMA 60014279172V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes172V00000XOther Service ProvidersCommunity Health Worker