Provider Demographics
NPI:1669704250
Name:ROSCOE, CHRISTINA M (RN)
Entity type:Individual
Prefix:
First Name:CHRISTINA
Middle Name:M
Last Name:ROSCOE
Suffix:
Gender:F
Credentials:RN
Other - Prefix:
Other - First Name:CHRISTINA
Other - Middle Name:M
Other - Last Name:GEORGE
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:RN
Mailing Address - Street 1:4783 LAKE VALLEY DR
Mailing Address - Street 2:APT#2D
Mailing Address - City:LISLE
Mailing Address - State:IL
Mailing Address - Zip Code:60532-3705
Mailing Address - Country:US
Mailing Address - Phone:404-547-8259
Mailing Address - Fax:
Practice Address - Street 1:4783 LAKE VALLEY DR
Practice Address - Street 2:2D
Practice Address - City:LISLE
Practice Address - State:IL
Practice Address - Zip Code:60532-3705
Practice Address - Country:US
Practice Address - Phone:404-547-8259
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-02-05
Last Update Date:2010-02-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GARN198196163W00000X
IL041.379953163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse