MEDICARE: CHRISTINA M TRAHIN

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	28162845A	IN
2	363LF0000X	Family Nurse Practitioner	71007405A	IN

General Provider Information

NPI Number	:	1548780109
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	CHRISTINA M TRAHIN

Provider Business Mailing Address
First Line	:	11109 PARKVIEW PLAZA DR # 117
Second Line	:
City	:	FORT WAYNE
State	:	IN
Zip	:	46845-1701
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	6920 POINTE INVERNESS WAY STE 120
Second Line	:
City	:	FORT WAYNE
State	:	IN
Zip	:	46804-7926
Country	:	US
Telephone Number	:	260-436-4060
Fax Number	:

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

Provider Enumeration Date	:	06/26/2017
Last Update Date	:	07/21/2022

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