Provider Demographics
NPI:1295999811
Name:LEDOUX, CHRISTINE FRANCES (CMF)
Entity type:Individual
Prefix:MRS
First Name:CHRISTINE
Middle Name:FRANCES
Last Name:LEDOUX
Suffix:
Gender:F
Credentials:CMF
Other - Prefix:MISS
Other - First Name:CHRISTINE
Other - Middle Name:FRANCES
Other - Last Name:KRUEGER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:4680 S EASTERN AVE STE H
Mailing Address - Street 2:
Mailing Address - City:LAS VEGAS
Mailing Address - State:NV
Mailing Address - Zip Code:89119-6192
Mailing Address - Country:US
Mailing Address - Phone:702-641-9666
Mailing Address - Fax:702-641-0732
Practice Address - Street 1:4680 S EASTERN AVE STE H
Practice Address - Street 2:
Practice Address - City:LAS VEGAS
Practice Address - State:NV
Practice Address - Zip Code:89119-6192
Practice Address - Country:US
Practice Address - Phone:702-641-9666
Practice Address - Fax:702-641-0732
Is Sole Proprietor?:Yes
Enumeration Date:2008-07-13
Last Update Date:2008-07-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes335E00000XSuppliersProsthetic/Orthotic Supplier
Provider Identifiers
StateIdentifier IDID TypeIssuer
NV003302519Medicaid
NV0870870001Medicare NSC