Healthcare Provider Details

I. General information

NPI: 1770105629
Provider Name (Legal Business Name): CHRISTINE MARIE MAHONE APRN
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/14/2020
Last Update Date: 10/12/2020
Certification Date: 10/12/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

10085 DOUBLE R BLVD STE 310
RENO NV
89521-4832
US

IV. Provider business mailing address

1155 MILL ST # M14
RENO NV
89502-1576
US

V. Phone/Fax

Practice location:
  • Phone: 775-982-7260
  • Fax: 775-982-7268
Mailing address:
  • Phone: 775-098-5262
  • Fax: 775-982-5496

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code163WC0400X
TaxonomyCase Management Registered Nurse
License NumberRN30476
License Number StateNV
# 2
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number832270
License Number StateNV

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: