Basic Information
Provider Information
NPI: 1184739518
EntityType: 1
ReplacementNPI:  
OrganizationName:  
LastName: LIMON
FirstName: CHRISTINE
MiddleName:  
NamePrefix: MS.
NameSuffix:  
Credential: RN
OtherOrganizationName:  
OtherOrganizationType:  
OtherLastName:  
OtherFirstName:  
OtherMiddleName:  
OtherNamePrefix:  
OtherNameSuffix:  
OtherCredential:  
OtherLastNameType:  
Mailing Information
Address1: 6016 SIPAPU AVE NW
Address2:  
City: ALBUQUERQUE
State: NM
PostalCode: 871203731
CountryCode: US
TelephoneNumber: 5058985366
FaxNumber:  
Practice Location
Address1: 1501 SAN PEDRO DR SE
Address2:  
City: ALBUQUERQUE
State: NM
PostalCode: 871085153
CountryCode: US
TelephoneNumber: 5052651711
FaxNumber: 5052562728
Other Information
ProviderEnumerationDate: 08/19/2006
LastUpdateDate: 07/08/2007
NPIDeactivationReasonCode:  
NPIDeactivationDate:  
NPIReactivationDate:  
ProviderGenderCode: F
AuthorizedOfficialLastName:  
AuthorizedOfficialFirstName:  
AuthorizedOfficialMiddleName:  
AuthorizedOfficialTitleorPosition:  
AuthorizedOfficialTelephone:  
IsSoleProprietor: Y
IsOrganizationSubpart:  
ParentOrganizationLBN:  
AuthorizedOfficialNamePrefix:  
AuthorizedOfficialNameSuffix:  
AuthorizedOfficialCredential:  
NPICertificationDate:  

Taxonomy Information
TaxonomyLicenseStateSwitchTaxonomyGroupTaxonomyTypeTaxonomyClassSubSpecialty
163WP0809XR16019NMY Nursing Service ProvidersRegistered NursePsych/Mental Health, Adult

No ID Information.


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