Healthcare Provider Details

I. General information

NPI: 1972274025
Provider Name (Legal Business Name): CHRISTINE KAY MOCKENSTURM
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/27/2021
Last Update Date: 09/27/2021
Certification Date: 09/27/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

11740 SUGAR RIDGE RD
BOWLING GREEN OH
43402-9611
US

IV. Provider business mailing address

11740 SUGAR RIDGE RD
BOWLING GREEN OH
43402-9611
US

V. Phone/Fax

Practice location:
  • Phone: 419-376-9124
  • Fax:
Mailing address:
  • Phone: 419-376-9124
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code374U00000X
TaxonomyHome Health Aide
License Number
License Number StateNULL
# 2
Primary TaxonomyN
Taxonomy Code172A00000X
TaxonomyDriver
License Number
License Number StateNULL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: