Healthcare Provider Details

I. General information

NPI: 1205028891
Provider Name (Legal Business Name): CHRISTINE JULIANA SMITH ANP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: CHRISTINA JULIANA SCHWALM; DEBRESTIAN

II. Dates (important events)

Enumeration Date: 08/16/2007
Last Update Date: 12/12/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1313 E OSBORN RD SUITE B150
PHOENIX AZ
85014-5678
US

IV. Provider business mailing address

1313 E OSBORN RD SUITE B150
PHOENIX AZ
85014-5678
US

V. Phone/Fax

Practice location:
  • Phone: 602-264-4431
  • Fax: 602-266-3870
Mailing address:
  • Phone: 602-264-4431
  • Fax: 602-266-3870

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LA2200X
TaxonomyAdult Health Nurse Practitioner
License NumberAP2754
License Number StateAZ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: