Healthcare Provider Details

I. General information

NPI: 1104248038
Provider Name (Legal Business Name): MRS. CHRISTINE RENEE SAIN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/12/2014
Last Update Date: 01/12/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

137 SCHAEFER DR
DOVER AR
72837-7923
US

IV. Provider business mailing address

137 SCHAEFER DR
DOVER AR
72837-7923
US

V. Phone/Fax

Practice location:
  • Phone: 479-970-1998
  • Fax:
Mailing address:
  • Phone: 479-970-1998
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code171M00000X
TaxonomyCase Manager/Care Coordinator
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: