Provider Demographics
NPI:1194247874
Name:HARRISON, CHRISTINE LORENTZEN (RN)
Entity type:Individual
Prefix:
First Name:CHRISTINE
Middle Name:LORENTZEN
Last Name:HARRISON
Suffix:
Gender:F
Credentials:RN
Other - Prefix:
Other - First Name:CHRISTINE
Other - Middle Name:WENDY
Other - Last Name:LORENTZEN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:555 HOSPITAL LN
Mailing Address - Street 2:
Mailing Address - City:SUSANVILLE
Mailing Address - State:CA
Mailing Address - Zip Code:96130-4808
Mailing Address - Country:US
Mailing Address - Phone:530-251-8108
Mailing Address - Fax:530-251-8108
Practice Address - Street 1:555 HOSPITAL LANE
Practice Address - Street 2:
Practice Address - City:SUSANVILLE
Practice Address - State:CA
Practice Address - Zip Code:96130
Practice Address - Country:US
Practice Address - Phone:530-251-8108
Practice Address - Fax:530-251-8394
Is Sole Proprietor?:Yes
Enumeration Date:2017-07-13
Last Update Date:2017-07-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA482139163WP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WP0808XNursing Service ProvidersRegistered NursePsychiatric/Mental Health