Provider Demographics
NPI:1215437793
Name:MATULIK, CHRISTINA ANN (LVN)
Entity type:Individual
Prefix:
First Name:CHRISTINA
Middle Name:ANN
Last Name:MATULIK
Suffix:
Gender:F
Credentials:LVN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4912 S PEA RIDGE RD
Mailing Address - Street 2:
Mailing Address - City:TEMPLE
Mailing Address - State:TX
Mailing Address - Zip Code:76502-5700
Mailing Address - Country:US
Mailing Address - Phone:254-231-6521
Mailing Address - Fax:
Practice Address - Street 1:4912 S PEA RIDGE RD
Practice Address - Street 2:
Practice Address - City:TEMPLE
Practice Address - State:TX
Practice Address - Zip Code:76502-5700
Practice Address - Country:US
Practice Address - Phone:254-232-6521
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-02-20
Last Update Date:2018-02-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX200905164X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164X00000XNursing Service ProvidersLicensed Vocational Nurse