Provider Demographics
NPI:1801354105
Name:ANDERSON, CHRISTA K (RN)
Entity type:Individual
Prefix:
First Name:CHRISTA
Middle Name:K
Last Name:ANDERSON
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 1:1225 JOSEPHINE ST APT 1
Mailing Address - Street 2:
Mailing Address - City:DENVER
Mailing Address - State:CO
Mailing Address - Zip Code:80206-3190
Mailing Address - Country:US
Mailing Address - Phone:267-987-0741
Mailing Address - Fax:
Practice Address - Street 1:1225 JOSEPHINE ST APT 1
Practice Address - Street 2:
Practice Address - City:DENVER
Practice Address - State:CO
Practice Address - Zip Code:80206-3190
Practice Address - Country:US
Practice Address - Phone:267-987-0741
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-03-05
Last Update Date:2019-03-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CORN.0200153163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse