Healthcare Provider Details

I. General information

NPI: 1740709104
Provider Name (Legal Business Name): CHRISTIE LOU MCMAHILL RNC
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/15/2017
Last Update Date: 09/15/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

MADIGAN ARMY MEDICAL CENTER 9040 JACKSON AVE., ATTN: MCHJ-CLQ-C
TACOMA WA
98431-1100
US

IV. Provider business mailing address

MADIGAN ARMY MEDICAL CENTER 9040 JACKSON AVE, ATTN: MCHJ-CLQ-C
TACOMA WA
98431-1100
US

V. Phone/Fax

Practice location:
  • Phone: 253-677-3760
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163WN0002X
TaxonomyNeonatal Intensive Care Registered Nurse
License Number00158852
License Number StateWA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: