Healthcare Provider Details

I. General information

NPI: 1073089926
Provider Name (Legal Business Name): CHRISTINA MARIE HANNAH PA
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/18/2018
Last Update Date: 09/11/2025
Certification Date: 10/27/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

184 UNSER BLVD NE
RIO RANCHO NM
87124-4045
US

IV. Provider business mailing address

PO BOX 740018
ATLANTA GA
30374-0018
US

V. Phone/Fax

Practice location:
  • Phone: 505-896-0928
  • Fax:
Mailing address:
  • Phone: 312-733-9730
  • Fax: 773-866-8014

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License NumberPA2018-0064
License Number StateNM

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: