Healthcare Provider Details

I. General information

NPI: 1790541753
Provider Name (Legal Business Name): CHRISTINA PUTNAM
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

Provider Other Name: CHRISSY PUTNAM JOLIE CHEVEUX OF LEX

II. Dates (important events)

Enumeration Date: 02/26/2024
Last Update Date: 05/20/2025
Certification Date: 05/20/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

11196 OLD US HIGHWAY 52
WINSTON SALEM NC
27107-9467
US

IV. Provider business mailing address

11196 OLD US HIGHWAY 52
WINSTON SALEM NC
27107-9467
US

V. Phone/Fax

Practice location:
  • Phone: 336-408-9327
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code335E00000X
TaxonomyProsthetic/Orthotic Supplier
License Number
License Number StateNULL
# 2
Primary TaxonomyY
Taxonomy Code224P00000X
TaxonomyProsthetist
License Number
License Number StateNULL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: