Provider Demographics
NPI:1013329465
Name:LENARDUZZI, CHRISTINA CLARE
Entity Type:Individual
Prefix:MISS
First Name:CHRISTINA
Middle Name:CLARE
Last Name:LENARDUZZI
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 1:122 GAYOSO AVE APT 406
Mailing Address - Street 2:
Mailing Address - City:MEMPHIS
Mailing Address - State:TN
Mailing Address - Zip Code:38103-2968
Mailing Address - Country:US
Mailing Address - Phone:662-312-8599
Mailing Address - Fax:
Practice Address - Street 1:122 GAYOSO AVE APT 406
Practice Address - Street 2:
Practice Address - City:MEMPHIS
Practice Address - State:TN
Practice Address - Zip Code:38103-2968
Practice Address - Country:US
Practice Address - Phone:662-312-8599
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2014-05-20
Last Update Date:2017-12-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MSR876973163W00000X
TN18847367500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes367500000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Anesthetist, Certified RegisteredGroup - Single Specialty
No163W00000XNursing Service ProvidersRegistered NurseGroup - Single Specialty