Healthcare Provider Details

I. General information

NPI: 1346528866
Provider Name (Legal Business Name): CHRISTIE ANNE CLINE MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/01/2011
Last Update Date: 08/01/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8905 OSUNA RD NE
ALBUQUERQUE NM
87111-2139
US

IV. Provider business mailing address

12231 ACADEMY RD NE # 301-313
ALBUQUERQUE NM
87111-7236
US

V. Phone/Fax

Practice location:
  • Phone: 505-379-6145
  • Fax:
Mailing address:
  • Phone: 505-379-6145
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2084P0800X
TaxonomyPsychiatry Physician
License Number98-240
License Number StateNM

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: