Provider Demographics
NPI:1841873882
Name:PASSANISE, CHRISTINA (MPS)
Entity type:Individual
Prefix:
First Name:CHRISTINA
Middle Name:
Last Name:PASSANISE
Suffix:
Gender:F
Credentials:MPS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:645 CROWN POINTE ESTATES CT
Mailing Address - Street 2:
Mailing Address - City:WILDWOOD
Mailing Address - State:MO
Mailing Address - Zip Code:63021-2013
Mailing Address - Country:US
Mailing Address - Phone:314-409-6701
Mailing Address - Fax:
Practice Address - Street 1:14131 CLAYTON RD
Practice Address - Street 2:
Practice Address - City:CHESTERFIELD
Practice Address - State:MO
Practice Address - Zip Code:63017-8355
Practice Address - Country:US
Practice Address - Phone:636-220-8181
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-04-28
Last Update Date:2021-04-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO2019045339246ZA2600X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes246ZA2600XTechnologists, Technicians & Other Technical Service ProvidersSpecialist/Technologist, OtherArt, Medical
Provider Identifiers
StateIdentifier IDID TypeIssuer
MO2019045339OtherMISSOURI STATE BOARDS TATTOO LICENSE