Healthcare Provider Details

I. General information

NPI: 1841330628
Provider Name (Legal Business Name): CHRISTINE MARION OWEN CARRON RN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/08/2007
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1330 E CARSON DR
TEMPE AZ
85282-7105
US

IV. Provider business mailing address

1330 E CARSON DR
TEMPE AZ
85282-7105
US

V. Phone/Fax

Practice location:
  • Phone: 480-897-2744
  • Fax: 480-839-7325
Mailing address:
  • Phone: 480-897-2744
  • Fax: 480-839-7325

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License NumberRN079923
License Number StateAZ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: