Provider Demographics
NPI:1306492046
Name:AZODE, CHRISTIAN M (APRN-PMHNP-BC)
Entity type:Individual
Prefix:DR
First Name:CHRISTIAN
Middle Name:M
Last Name:AZODE
Suffix:
Gender:M
Credentials:APRN-PMHNP-BC
Other - Prefix:DR
Other - First Name:CHRIS
Other - Middle Name:MADUABUCHI
Other - Last Name:AZODE
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:1800 E VAN BUREN ST
Mailing Address - Street 2:
Mailing Address - City:PHOENIX
Mailing Address - State:AZ
Mailing Address - Zip Code:85006-3742
Mailing Address - Country:US
Mailing Address - Phone:602-251-8181
Mailing Address - Fax:
Practice Address - Street 1:1800 E VAN BUREN ST
Practice Address - Street 2:
Practice Address - City:PHOENIX
Practice Address - State:AZ
Practice Address - Zip Code:85006-3742
Practice Address - Country:US
Practice Address - Phone:602-251-8181
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-08-16
Last Update Date:2020-01-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ175450163WP0808X
AZ230893363LP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health
No163WP0808XNursing Service ProvidersRegistered NursePsychiatric/Mental Health