Provider Demographics
NPI:1932149648
Name:TAPP, CHRISTINA R
Entity Type:Individual
Prefix:
First Name:CHRISTINA
Middle Name:R
Last Name:TAPP
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 1:543 W ANNDON ST
Mailing Address - Street 2:
Mailing Address - City:BRAIDWOOD
Mailing Address - State:IL
Mailing Address - Zip Code:60408-1474
Mailing Address - Country:US
Mailing Address - Phone:815-458-6295
Mailing Address - Fax:
Practice Address - Street 1:PROVENA ST. MARY HOSPITAL
Practice Address - Street 2:500 W. COURT ST.
Practice Address - City:KANKAKEE
Practice Address - State:IL
Practice Address - Zip Code:60901-3697
Practice Address - Country:US
Practice Address - Phone:815-937-2454
Practice Address - Fax:815-928-6213
Is Sole Proprietor?:No
Enumeration Date:2006-06-08
Last Update Date:2007-11-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered
Provider Identifiers
StateIdentifier IDID TypeIssuer
ILK28170Medicare PIN