Basic Information
Provider Information | |||||||||
NPI: | 1073033262 | ||||||||
EntityType: | 1 | ||||||||
ReplacementNPI: |   | ||||||||
OrganizationName: |   | ||||||||
LastName: | CREEDEN | ||||||||
FirstName: | CHRISTINA | ||||||||
MiddleName: | M | ||||||||
NamePrefix: |   | ||||||||
NameSuffix: |   | ||||||||
Credential: | NP-C | ||||||||
OtherOrganizationName: |   | ||||||||
OtherOrganizationType: |   | ||||||||
OtherLastName: | WAMMACK, DOWDLE | ||||||||
OtherFirstName: | CHRISTINA | ||||||||
OtherMiddleName: |   | ||||||||
OtherNamePrefix: |   | ||||||||
OtherNameSuffix: |   | ||||||||
OtherCredential: |   | ||||||||
OtherLastNameType: | 1 | ||||||||
Mailing Information | |||||||||
Address1: | PO BOX 992790 | ||||||||
Address2: |   | ||||||||
City: | REDDING | ||||||||
State: | CA | ||||||||
PostalCode: | 960992790 | ||||||||
CountryCode: | US | ||||||||
TelephoneNumber: | 5302465710 | ||||||||
FaxNumber: | 8709947488 | ||||||||
Practice Location | |||||||||
Address1: | 2965 EAST ST | ||||||||
Address2: |   | ||||||||
City: | ANDERSON | ||||||||
State: | CA | ||||||||
PostalCode: | 960073481 | ||||||||
CountryCode: | US | ||||||||
TelephoneNumber: | 3037804865 | ||||||||
FaxNumber: | 5303570582 | ||||||||
Other Information | |||||||||
ProviderEnumerationDate: | 06/20/2017 | ||||||||
LastUpdateDate: | 11/24/2020 | ||||||||
NPIDeactivationReasonCode: |   | ||||||||
NPIDeactivationDate: |   | ||||||||
NPIReactivationDate: |   | ||||||||
ProviderGenderCode: | F | ||||||||
AuthorizedOfficialLastName: |   | ||||||||
AuthorizedOfficialFirstName: |   | ||||||||
AuthorizedOfficialMiddleName: |   | ||||||||
AuthorizedOfficialTitleorPosition: |   | ||||||||
AuthorizedOfficialTelephone: |   | ||||||||
IsSoleProprietor: | N | ||||||||
IsOrganizationSubpart: |   | ||||||||
ParentOrganizationLBN: |   | ||||||||
AuthorizedOfficialNamePrefix: |   | ||||||||
AuthorizedOfficialNameSuffix: |   | ||||||||
AuthorizedOfficialCredential: |   | ||||||||
NPICertificationDate: | 11/24/2020 |
Taxonomy Information
Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 363LF0000X | A005178 | AR | Y |   | Physician Assistants & Advanced Practice Nursing Providers | Nurse Practitioner | Family |
ID Information
ID | Type | State | Issuer | Description | A005178 | 01 | AR | APRN LICENSE | OTHER |