Provider Demographics
NPI:1982479556
Name:TANOUS, CHRISTINE LOUISE
Entity Type:Individual
Prefix:
First Name:CHRISTINE
Middle Name:LOUISE
Last Name:TANOUS
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:CHRISTINE
Other - Middle Name:LOUISE
Other - Last Name:KISCH
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:901 OAK PARK BLVD STE 101
Mailing Address - Street 2:
Mailing Address - City:PISMO BEACH
Mailing Address - State:CA
Mailing Address - Zip Code:93449-3409
Mailing Address - Country:US
Mailing Address - Phone:805-481-2205
Mailing Address - Fax:805-481-2206
Practice Address - Street 1:901 OAK PARK BLVD STE 101
Practice Address - Street 2:
Practice Address - City:PISMO BEACH
Practice Address - State:CA
Practice Address - Zip Code:93449-3409
Practice Address - Country:US
Practice Address - Phone:805-481-2205
Practice Address - Fax:805-481-2206
Is Sole Proprietor?:No
Enumeration Date:2023-11-23
Last Update Date:2024-03-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA95027517363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily