Provider Demographics
NPI:1588951834
Name:HULSEBOS, CHRISTINA LOUISE (DPM)
Entity type:Individual
Prefix:DR
First Name:CHRISTINA
Middle Name:LOUISE
Last Name:HULSEBOS
Suffix:
Gender:F
Credentials:DPM
Other - Prefix:DR
Other - First Name:CHRISTINA
Other - Middle Name:LOUISE
Other - Last Name:LANGE
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:DPM
Mailing Address - Street 1:1850 E SAHARA AVE STE 202
Mailing Address - Street 2:
Mailing Address - City:LAS VEGAS
Mailing Address - State:NV
Mailing Address - Zip Code:89104-3746
Mailing Address - Country:US
Mailing Address - Phone:702-551-7199
Mailing Address - Fax:702-850-2965
Practice Address - Street 1:1850 E SAHARA AVE STE 202
Practice Address - Street 2:
Practice Address - City:LAS VEGAS
Practice Address - State:NV
Practice Address - Zip Code:89104-3746
Practice Address - Country:US
Practice Address - Phone:702-551-7199
Practice Address - Fax:702-850-2965
Is Sole Proprietor?:No
Enumeration Date:2011-07-07
Last Update Date:2017-10-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAEL1892213ES0103X
CAE5127213ES0103X
NV2021213ES0103X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes213ES0103XPodiatric Medicine & Surgery Service ProvidersPodiatristFoot & Ankle Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
CACB219533Medicare PIN