Provider Demographics
NPI:1992018394
Name:IANNACCONE, CHRISTOPHER L (BS, BSN, RN)
Entity Type:Individual
Prefix:
First Name:CHRISTOPHER
Middle Name:L
Last Name:IANNACCONE
Suffix:
Gender:M
Credentials:BS, BSN, RN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:10061 E CAROLINA DR
Mailing Address - Street 2:101
Mailing Address - City:DENVER
Mailing Address - State:CO
Mailing Address - Zip Code:80247-1994
Mailing Address - Country:US
Mailing Address - Phone:912-660-5235
Mailing Address - Fax:
Practice Address - Street 1:10061 E CAROLINA DR
Practice Address - Street 2:101
Practice Address - City:DENVER
Practice Address - State:CO
Practice Address - Zip Code:80247-1994
Practice Address - Country:US
Practice Address - Phone:912-660-5235
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2010-07-14
Last Update Date:2010-07-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GARN198784163W00000X
CO193003163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse