Provider Demographics
NPI:1992572754
Name:MUCK, CHRISTI L
Entity type:Individual
Prefix:
First Name:CHRISTI
Middle Name:L
Last Name:MUCK
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 1:1640 W KEETOOWAH ST
Mailing Address - Street 2:
Mailing Address - City:TAHLEQUAH
Mailing Address - State:OK
Mailing Address - Zip Code:74464-3497
Mailing Address - Country:US
Mailing Address - Phone:918-931-5782
Mailing Address - Fax:
Practice Address - Street 1:16414 W 760 RD
Practice Address - Street 2:
Practice Address - City:TAHLEQUAH
Practice Address - State:OK
Practice Address - Zip Code:74464-1675
Practice Address - Country:US
Practice Address - Phone:918-931-5782
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-12-11
Last Update Date:2023-12-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes175T00000XOther Service ProvidersPeer Specialist