Provider Demographics
NPI:1831536788
Name:MCENERNEY, CHRISTA MARIE (DO)
Entity type:Individual
Prefix:
First Name:CHRISTA
Middle Name:MARIE
Last Name:MCENERNEY
Suffix:
Gender:F
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7214 W TETHER TRL
Mailing Address - Street 2:
Mailing Address - City:PEORIA
Mailing Address - State:AZ
Mailing Address - Zip Code:85383-7341
Mailing Address - Country:US
Mailing Address - Phone:515-864-6562
Mailing Address - Fax:
Practice Address - Street 1:75 STATE ST FL 26
Practice Address - Street 2:
Practice Address - City:BOSTON
Practice Address - State:MA
Practice Address - Zip Code:02109-1827
Practice Address - Country:US
Practice Address - Phone:855-635-1393
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-06-02
Last Update Date:2023-05-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ6883207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine