Provider Demographics
NPI:1649445370
Name:HAHNFELD-JORDAN, CHRISTINA DIANE (RN)
Entity type:Individual
Prefix:
First Name:CHRISTINA
Middle Name:DIANE
Last Name:HAHNFELD-JORDAN
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:S10136 BEAR VALLEY RD
Mailing Address - Street 2:
Mailing Address - City:LONE ROCK
Mailing Address - State:WI
Mailing Address - Zip Code:53556-9601
Mailing Address - Country:US
Mailing Address - Phone:608-583-2368
Mailing Address - Fax:
Practice Address - Street 1:S10136 BEAR VALLEY RD
Practice Address - Street 2:
Practice Address - City:LONE ROCK
Practice Address - State:WI
Practice Address - Zip Code:53556-9601
Practice Address - Country:US
Practice Address - Phone:608-583-2368
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-04-23
Last Update Date:2008-04-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI71051-30163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse
Provider Identifiers
StateIdentifier IDID TypeIssuer
WI39977600Medicaid