Healthcare Provider Details

I. General information

NPI: 1619468295
Provider Name (Legal Business Name): CHRISTINE S GWIN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/19/2018
Last Update Date: 05/19/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

850 MILL ST STE 100
RENO NV
89502-1463
US

IV. Provider business mailing address

2560 BUSINESS PKWY
MINDEN NV
89423-8985
US

V. Phone/Fax

Practice location:
  • Phone: 775-538-6700
  • Fax:
Mailing address:
  • Phone: 775-901-8164
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License NumberCSW.09924976
License Number StateCO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: