Healthcare Provider Details

I. General information

NPI: 1326382607
Provider Name (Legal Business Name): CHRISTINA MARIE OUTLAW CNS
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 11/26/2012
Last Update Date: 09/17/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

9250 COLUMBIA AVE STE 2E
MUNSTER IN
46321-3530
US

IV. Provider business mailing address

4440 W GUADALUPE CIR
EAST CHICAGO IN
46312-3159
US

V. Phone/Fax

Practice location:
  • Phone: 195-950-0432
  • Fax: 219-237-2894
Mailing address:
  • Phone: 219-688-4279
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code364SP0808X
TaxonomyPsychiatric/Mental Health Clinical Nurse Specialist
License Number71004110A
License Number StateIN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: