Provider Demographics
NPI:1902631138
Name:SANCRISTOFUL-CHOUINARD, ANTONIA FRANCE
Entity type:Individual
Prefix:
First Name:ANTONIA
Middle Name:FRANCE
Last Name:SANCRISTOFUL-CHOUINARD
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1021 ANISE CT
Mailing Address - Street 2:
Mailing Address - City:BOWLING GREEN
Mailing Address - State:KY
Mailing Address - Zip Code:42104-7789
Mailing Address - Country:US
Mailing Address - Phone:270-901-9535
Mailing Address - Fax:
Practice Address - Street 1:420 OLD MORGANTOWN RD STE 4
Practice Address - Street 2:
Practice Address - City:BOWLING GREEN
Practice Address - State:KY
Practice Address - Zip Code:42101-2842
Practice Address - Country:US
Practice Address - Phone:270-901-9535
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-09-06
Last Update Date:2024-09-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY5004283747P1801X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3747P1801XNursing Service Related ProvidersTechnicianPersonal Care Attendant