Provider Demographics
NPI:1265760144
Name:PROEFROCK, CHRISTINA L (RN)
Entity type:Individual
Prefix:
First Name:CHRISTINA
Middle Name:L
Last Name:PROEFROCK
Suffix:
Gender:F
Credentials:RN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:27 JOSEPH DR APT A
Mailing Address - Street 2:
Mailing Address - City:TONAWANDA
Mailing Address - State:NY
Mailing Address - Zip Code:14150-6251
Mailing Address - Country:US
Mailing Address - Phone:716-946-5867
Mailing Address - Fax:
Practice Address - Street 1:27 JOSEPH DR APT A
Practice Address - Street 2:
Practice Address - City:TONAWANDA
Practice Address - State:NY
Practice Address - Zip Code:14150-6251
Practice Address - Country:US
Practice Address - Phone:716-946-5867
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2009-12-03
Last Update Date:2012-08-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY645508163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse