Healthcare Provider Details

I. General information

NPI: 1821349713
Provider Name (Legal Business Name): CHRISTINE KING LPN, CNA
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 10/02/2012
Last Update Date: 10/18/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

136 CEDAR ST
KINGSTON NY
12401-4934
US

IV. Provider business mailing address

136 CEDAR ST
KINGSTON NY
12401-4934
US

V. Phone/Fax

Practice location:
  • Phone: 518-821-9092
  • Fax:
Mailing address:
  • Phone: 518-821-9092
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code376K00000X
TaxonomyNurse's Aide
License Number
License Number StateNULL
# 2
Primary TaxonomyY
Taxonomy Code164W00000X
TaxonomyLicensed Practical Nurse
License Number307743
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: