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General NPI Number Information
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NPI Number | 1063415404
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Entity Type | Individual
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Provider Name | CHRISTINE C SCHALLER MD
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Gender | Female
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Dates
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Enumeration Date | 05/31/2005
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Last Update Date | 11/01/2012
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Provider Practice Location Address
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Address Line | 2315 8TH ST
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City | LEWISTON
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State | ID
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Zip | 83501-7301
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Country | US
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Telephone | 208-983-5120
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Fax | 208-983-5404
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Provider Business Mailing Address
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Address Line | 77 POPLAR DR
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City | GRANGEVILLE
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State | ID
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Zip | 83530-5347
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Country | US
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Telephone | 208-983-3744
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Fax | 208-298-4520
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207Q00000X
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Taxonomy Name | Family Medicine Physician
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License Number | M9461
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License Number State | ID
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