Healthcare Provider Details

I. General information

NPI: 1588951834
Provider Name (Legal Business Name): CHRISTINA LOUISE HULSEBOS DPM
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: CHRISTINA LOUISE LANGE DPM

II. Dates (important events)

Enumeration Date: 07/07/2011
Last Update Date: 10/02/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1850 E SAHARA AVE STE 202
LAS VEGAS NV
89104-3746
US

IV. Provider business mailing address

1850 E SAHARA AVE STE 202
LAS VEGAS NV
89104-3746
US

V. Phone/Fax

Practice location:
  • Phone: 702-551-7199
  • Fax: 702-850-2965
Mailing address:
  • Phone: 702-551-7199
  • Fax: 702-850-2965

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code213ES0103X
TaxonomyFoot & Ankle Surgery Podiatrist
License NumberEL1892
License Number StateCA
# 2
Primary TaxonomyN
Taxonomy Code213ES0103X
TaxonomyFoot & Ankle Surgery Podiatrist
License NumberE5127
License Number StateCA
# 3
Primary TaxonomyY
Taxonomy Code213ES0103X
TaxonomyFoot & Ankle Surgery Podiatrist
License Number2021
License Number StateNV

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: