Provider Demographics
NPI:1669252706
Name:NELSON, CHRISTINE MAE (RT)
Entity type:Individual
Prefix:
First Name:CHRISTINE
Middle Name:MAE
Last Name:NELSON
Suffix:
Gender:F
Credentials:RT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:14623 W PLUM RD
Mailing Address - Street 2:
Mailing Address - City:SURPRISE
Mailing Address - State:AZ
Mailing Address - Zip Code:85387-7062
Mailing Address - Country:US
Mailing Address - Phone:162-399-9731
Mailing Address - Fax:
Practice Address - Street 1:6516 W BRADSHAW DR
Practice Address - Street 2:
Practice Address - City:PINE
Practice Address - State:AZ
Practice Address - Zip Code:85544-5083
Practice Address - Country:US
Practice Address - Phone:623-999-7313
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-10-05
Last Update Date:2023-10-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZCRT-062852085R0202X
AZCTCT-711312471C3401X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2471C3401XTechnologists, Technicians & Other Technical Service ProvidersRadiologic TechnologistComputed Tomography
No2085R0202XAllopathic & Osteopathic PhysiciansRadiologyDiagnostic Radiology