Healthcare Provider Details

I. General information

NPI: 1184169161
Provider Name (Legal Business Name): MRS. CHRISTINA MARIE PICKENS
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/29/2016
Last Update Date: 12/29/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7175 COLUMBIA GATEWAY DR
COLUMBIA MD
21046-2534
US

IV. Provider business mailing address

P.O. BOX 66
VIENNA MD
21869
US

V. Phone/Fax

Practice location:
  • Phone: 888-344-5977
  • Fax:
Mailing address:
  • Phone: 580-574-1785
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code247200000X
TaxonomyOther Technician
License Number0
License Number StateMD

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: