Provider Demographics
NPI:1801589833
Name:DRAKE, CHRISTINA MARIE
Entity type:Individual
Prefix:
First Name:CHRISTINA
Middle Name:MARIE
Last Name:DRAKE
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:30140 COUNTY ROAD 353
Mailing Address - Street 2:
Mailing Address - City:BUENA VISTA
Mailing Address - State:CO
Mailing Address - Zip Code:81211-9772
Mailing Address - Country:US
Mailing Address - Phone:719-207-0506
Mailing Address - Fax:
Practice Address - Street 1:30140 COUNTY ROAD 353
Practice Address - Street 2:
Practice Address - City:BUENA VISTA
Practice Address - State:CO
Practice Address - Zip Code:81211-9772
Practice Address - Country:US
Practice Address - Phone:719-207-0506
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-05-26
Last Update Date:2023-09-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NA174H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174H00000XOther Service ProvidersHealth Educator