Healthcare Provider Details

I. General information

NPI: 1558999441
Provider Name (Legal Business Name): CHRISTOPHER COUNCIL RN
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/28/2020
Last Update Date: 03/29/2020
Certification Date: 03/29/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1210 E FREMONT DR
TEMPE AZ
85282-7116
US

IV. Provider business mailing address

1210 E FREMONT DR
TEMPE AZ
85282-7116
US

V. Phone/Fax

Practice location:
  • Phone: 602-538-6306
  • Fax:
Mailing address:
  • Phone: 602-538-6306
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163WE0003X
TaxonomyEmergency Registered Nurse
License NumberRN170644
License Number StateAZ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: