Provider Demographics
NPI:1396986592
Name:HORNE, CHRISTIE SHANN (LPN)
Entity type:Individual
Prefix:MRS
First Name:CHRISTIE
Middle Name:SHANN
Last Name:HORNE
Suffix:
Gender:F
Credentials:LPN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1637 HALLMARK HILLS DR
Mailing Address - Street 2:
Mailing Address - City:GRIFFIN
Mailing Address - State:GA
Mailing Address - Zip Code:30223-8790
Mailing Address - Country:US
Mailing Address - Phone:770-584-1707
Mailing Address - Fax:770-229-3067
Practice Address - Street 1:136 N HILL ST
Practice Address - Street 2:
Practice Address - City:GRIFFIN
Practice Address - State:GA
Practice Address - Zip Code:30223-3335
Practice Address - Country:US
Practice Address - Phone:770-358-8577
Practice Address - Fax:770-229-3067
Is Sole Proprietor?:No
Enumeration Date:2009-03-18
Last Update Date:2009-03-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GALPN063134164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse