Healthcare Provider Details

I. General information

NPI: 1134037336
Provider Name (Legal Business Name): CHRISTIN AVERY
Entity Type: Individual
Gender:
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/29/2026
Last Update Date: 08/29/2026
Certification Date: 08/29/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

704 BACK CREEK LN
MIDDLETOWN DE
19709-8838
US

IV. Provider business mailing address

704 BACK CREEK LN
MIDDLETOWN DE
19709-8838
US

V. Phone/Fax

Practice location:
  • Phone: 609-502-2840
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163WP0808X
TaxonomyPsychiatric/Mental Health Registered Nurse
License NumberL1-0068223
License Number StateDE

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: