Healthcare Provider Details

I. General information

NPI: 1376460642
Provider Name (Legal Business Name): CHRISTINE BOUAJAJA RN
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/30/2026
Last Update Date: 06/30/2026
Certification Date: 06/30/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

368 WHITNEY CT
IRWIN PA
15642-1910
US

IV. Provider business mailing address

368 WHITNEY CT
IRWIN PA
15642-1910
US

V. Phone/Fax

Practice location:
  • Phone: 412-639-0626
  • Fax:
Mailing address:
  • Phone: 412-639-0626
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163WM1400X
TaxonomyNurse Massage Therapist (NMT)
License Number309394L
License Number StatePA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: