Provider Demographics
NPI:1841330628
Name:OWEN CARRON, CHRISTINE MARION (RN)
Entity type:Individual
Prefix:MRS
First Name:CHRISTINE
Middle Name:MARION
Last Name:OWEN CARRON
Suffix:
Gender:F
Credentials:RN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1330 E CARSON DR
Mailing Address - Street 2:
Mailing Address - City:TEMPE
Mailing Address - State:AZ
Mailing Address - Zip Code:85282-7105
Mailing Address - Country:US
Mailing Address - Phone:480-897-2744
Mailing Address - Fax:480-839-7325
Practice Address - Street 1:1330 E CARSON DR
Practice Address - Street 2:
Practice Address - City:TEMPE
Practice Address - State:AZ
Practice Address - Zip Code:85282-7105
Practice Address - Country:US
Practice Address - Phone:480-897-2744
Practice Address - Fax:480-839-7325
Is Sole Proprietor?:No
Enumeration Date:2007-02-08
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZRN079923163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZ571689OtherAHCCCS PROVIDER ID