Provider Demographics
NPI:1669690269
Name:HAUCK, CHRISTINE RENEE (APRN)
Entity type:Individual
Prefix:MRS
First Name:CHRISTINE
Middle Name:RENEE
Last Name:HAUCK
Suffix:
Gender:F
Credentials:APRN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:11200 LERIDA LN
Mailing Address - Street 2:
Mailing Address - City:OKLAHOMA CITY
Mailing Address - State:OK
Mailing Address - Zip Code:73173-8158
Mailing Address - Country:US
Mailing Address - Phone:405-314-5266
Mailing Address - Fax:
Practice Address - Street 1:4400 GRANT BLVD
Practice Address - Street 2:
Practice Address - City:YUKON
Practice Address - State:OK
Practice Address - Zip Code:73099
Practice Address - Country:US
Practice Address - Phone:405-603-4660
Practice Address - Fax:405-470-3377
Is Sole Proprietor?:Yes
Enumeration Date:2007-04-22
Last Update Date:2021-03-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK0079042364SA2100X, 364SP0200X
OK79042363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
No364SA2100XPhysician Assistants & Advanced Practice Nursing ProvidersClinical Nurse SpecialistAcute Care
No364SP0200XPhysician Assistants & Advanced Practice Nursing ProvidersClinical Nurse SpecialistPediatrics