MEDICARE: DR. CHRISTINA NICOLE RADMER PSYD, LP

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	103T00000X	Psychologist	35203	TX
2	103T00000X	Psychologist	5291	MN

General Provider Information

NPI Number	:	1700160520
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. CHRISTINA NICOLE RADMER PSYD, LP

Provider Business Mailing Address
First Line	:	880 PROSPECTOR TRL STE 100
Second Line	:
City	:	HARKER HEIGHTS
State	:	TX
Zip	:	76548-2700
Country	:	US
Telephone Number	:	254-690-1512
Fax Number	:

Provider Business Practice Location Address
First Line	:	880 PROSPECTOR TRL STE 100
Second Line	:
City	:	HARKER HEIGHTS
State	:	TX
Zip	:	76548-2700
Country	:	US
Telephone Number	:	254-690-1512
Fax Number	:

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

Provider Enumeration Date	:	09/29/2011
Last Update Date	:	09/29/2011

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