Healthcare Provider Details

I. General information

NPI: 1740531466
Provider Name (Legal Business Name): CHRISTA ELIZABETH SECORD FNP-C
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/20/2012
Last Update Date: 09/20/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

160-12TH ST.
ELKO NV
89801
US

IV. Provider business mailing address

P.O. BOX 2710
ELKO NV
89801-2710
US

V. Phone/Fax

Practice location:
  • Phone: 775-738-2034
  • Fax: 775-738-3241
Mailing address:
  • Phone: 775-738-2034
  • Fax: 775-738-3241

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License NumberAPN001396
License Number StateNV

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: