Provider Demographics
NPI:1952570046
Name:MADDEN, CHRISTY D (CRNA)
Entity Type:Individual
Prefix:
First Name:CHRISTY
Middle Name:D
Last Name:MADDEN
Suffix:
Gender:F
Credentials:CRNA
Other - Prefix:
Other - First Name:CHRISTY
Other - Middle Name:D
Other - Last Name:FOWLER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:3301 S 14TH ST STE 16180
Mailing Address - Street 2:
Mailing Address - City:ABILENE
Mailing Address - State:TX
Mailing Address - Zip Code:79605-5015
Mailing Address - Country:US
Mailing Address - Phone:325-660-5535
Mailing Address - Fax:
Practice Address - Street 1:26732 CROWN VALLEY PKWY
Practice Address - Street 2:
Practice Address - City:MISSION VIEJO
Practice Address - State:CA
Practice Address - Zip Code:92691-6306
Practice Address - Country:US
Practice Address - Phone:949-364-2611
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2008-02-22
Last Update Date:2021-08-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA95000465367500000X
GARN159872367500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367500000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Anesthetist, Certified Registered