Provider Demographics
NPI:1912239393
Name:CHRISTIE, BRIAN A (LPN)
Entity type:Individual
Prefix:MR
First Name:BRIAN
Middle Name:A
Last Name:CHRISTIE
Suffix:
Gender:M
Credentials:LPN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7490 RIVER RD
Mailing Address - Street 2:
Mailing Address - City:BALDWINSVILLE
Mailing Address - State:NY
Mailing Address - Zip Code:13027-9450
Mailing Address - Country:US
Mailing Address - Phone:315-409-5387
Mailing Address - Fax:
Practice Address - Street 1:7490 RIVER RD
Practice Address - Street 2:
Practice Address - City:BALDWINSVILLE
Practice Address - State:NY
Practice Address - Zip Code:13027-9450
Practice Address - Country:US
Practice Address - Phone:315-409-5387
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-02-09
Last Update Date:2010-02-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY300239164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse