Healthcare Provider Details

I. General information

NPI: 1871023986
Provider Name (Legal Business Name): CHRISTY LORRAINE MICHALUK R.N.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: CHRISTY LORRAINE WATTS R.N.

II. Dates (important events)

Enumeration Date: 06/13/2017
Last Update Date: 06/13/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

538 W 5TH AVE
KNOXVILLE TN
37917-7109
US

IV. Provider business mailing address

6350 W ANDREW JOHNSON HWY DEPT 100
TALBOTT TN
37877-8605
US

V. Phone/Fax

Practice location:
  • Phone: 865-525-2404
  • Fax: 865-525-2212
Mailing address:
  • Phone: 800-355-3565
  • Fax: 423-714-2355

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License NumberRN213953
License Number StateTN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: