Healthcare Provider Details

I. General information

NPI: 1598582835
Provider Name (Legal Business Name): CHRISTINE NAISMITH WALTERS
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: CHRISTINE BERGENE

II. Dates (important events)

Enumeration Date: 09/25/2024
Last Update Date: 03/24/2025
Certification Date: 03/24/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3126 N CIVIC CENTER PLZ
SCOTTSDALE AZ
85251-6912
US

IV. Provider business mailing address

4529 E HEARN RD
PHOENIX AZ
85032-5552
US

V. Phone/Fax

Practice location:
  • Phone: 480-874-2040
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: