Provider Demographics
NPI:1154518397
Name:MULFORD, CHRISTINE RENEE (FNP)
Entity type:Individual
Prefix:
First Name:CHRISTINE
Middle Name:RENEE
Last Name:MULFORD
Suffix:
Gender:F
Credentials:FNP
Other - Prefix:
Other - First Name:CHRISTINE
Other - Middle Name:
Other - Last Name:MCFARLANE
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:FNP
Mailing Address - Street 1:4222 E KIRKLAND RD
Mailing Address - Street 2:
Mailing Address - City:PHOENIX
Mailing Address - State:AZ
Mailing Address - Zip Code:85050-8716
Mailing Address - Country:US
Mailing Address - Phone:757-870-8862
Mailing Address - Fax:
Practice Address - Street 1:4222 E KIRKLAND RD
Practice Address - Street 2:
Practice Address - City:PHOENIX
Practice Address - State:AZ
Practice Address - Zip Code:85050-8716
Practice Address - Country:US
Practice Address - Phone:757-870-8862
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-10-02
Last Update Date:2019-03-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZAP7406363LF0000X
VA0024164171363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA017045M58Medicare PIN
VA143966ZCCUMedicare PIN