Healthcare Provider Details

I. General information

NPI: 1932149648
Provider Name (Legal Business Name): CHRISTINA R TAPP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/08/2006
Last Update Date: 11/30/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

PROVENA ST. MARY HOSPITAL 500 W. COURT ST.
KANKAKEE IL
60901-3697
US

IV. Provider business mailing address

543 W ANNDON ST
BRAIDWOOD IL
60408-1474
US

V. Phone/Fax

Practice location:
  • Phone: 815-937-2454
  • Fax: 815-928-6213
Mailing address:
  • Phone: 815-458-6295
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code133V00000X
TaxonomyRegistered Dietitian
License Number
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: