MEDICARE: MRS. CHRISTINA MARIE SHUKER RN, CRNP

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	163W00000X	Registered Nurse	584684	PA
2	363L00000X	Nurse Practitioner	SP011956	PA
3	363LF0000X	Family Nurse Practitioner	AP10010	AZ

General Provider Information

NPI Number	:	1316205107
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MRS. CHRISTINA MARIE SHUKER RN, CRNP

Provider Business Mailing Address
First Line	:	PO BOX 6408
Second Line	:
City	:	SCOTTSDALE
State	:	AZ
Zip	:	85261-6408
Country	:	US
Telephone Number	:	480-563-6400
Fax Number	:	480-563-8009

Provider Business Practice Location Address
First Line	:	655 S DOBSON RD STE 205
Second Line	:
City	:	CHANDLER
State	:	AZ
Zip	:	85224-5669
Country	:	US
Telephone Number	:	480-563-6400
Fax Number	:	480-563-8009

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	04/30/2012
Last Update Date	:	04/28/2021

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