Provider Demographics
NPI:1245552363
Name:ATAKULU, CHRISTINA (LPN)
Entity type:Individual
Prefix:MS
First Name:CHRISTINA
Middle Name:
Last Name:ATAKULU
Suffix:
Gender:F
Credentials:LPN
Other - Prefix:MS
Other - First Name:CHRISTINA
Other - Middle Name:
Other - Last Name:ATAKULU
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:LPN
Mailing Address - Street 1:14972 WELLER LN
Mailing Address - Street 2:
Mailing Address - City:ROSEDALE
Mailing Address - State:NY
Mailing Address - Zip Code:11422-2735
Mailing Address - Country:US
Mailing Address - Phone:917-684-1419
Mailing Address - Fax:
Practice Address - Street 1:14972 WELLER LN
Practice Address - Street 2:
Practice Address - City:ROSEDALE
Practice Address - State:NY
Practice Address - Zip Code:11422-2735
Practice Address - Country:US
Practice Address - Phone:917-684-1419
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-02-16
Last Update Date:2019-11-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY278532164W00000X
NY278532; LPN164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse