MEDICARE: KRISTI CORTINA CLC

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	174N00000X	Lactation Consultant (Non-RN)

General Provider Information

NPI Number	:	1528772563
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	KRISTI CORTINA CLC

Provider Business Mailing Address
First Line	:	4532 W CORRINE DR
Second Line	:
City	:	GLENDALE
State	:	AZ
Zip	:	85304-2112
Country	:	US
Telephone Number	:	217-778-7257
Fax Number	:

Provider Business Practice Location Address
First Line	:	4532 W CORRINE DR
Second Line	:
City	:	GLENDALE
State	:	AZ
Zip	:	85304-2112
Country	:	US
Telephone Number	:	217-778-7257
Fax Number	:

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

Provider Enumeration Date	:	01/12/2023
Last Update Date	:	01/12/2023

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Directions to “ KRISTI CORTINA CLC” Practice Location

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