Basic Information
| Provider Information | |||||||||
| NPI: | 1376843052 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | CHANG | ||||||||
| FirstName: | CHRISTINA | ||||||||
| MiddleName: | MARIE | ||||||||
| NamePrefix: | MRS. | ||||||||
| NameSuffix: | |||||||||
| Credential: | NP | ||||||||
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| Mailing Information | |||||||||
| Address1: | 7112 ED BLUESTEIN BLVD STE 105 | ||||||||
| Address2: | |||||||||
| City: | AUSTIN | ||||||||
| State: | TX | ||||||||
| PostalCode: | 787232913 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5129789200 | ||||||||
| FaxNumber: | 5129019756 | ||||||||
| Practice Location | |||||||||
| Address1: | 7112 ED BLUESTEIN BLVD STE 105 | ||||||||
| Address2: | |||||||||
| City: | AUSTIN | ||||||||
| State: | TX | ||||||||
| PostalCode: | 787232913 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5129789200 | ||||||||
| FaxNumber: | 5129019756 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 10/27/2010 | ||||||||
| LastUpdateDate: | 05/26/2022 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | 05/26/2022 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 163W00000X | 697889 | TX | N | Nursing Service Providers | Registered Nurse | 363LF0000X | 697889 | TX | N | Physician Assistants & Advanced Practice Nursing Providers | Nurse Practitioner | Family | 363LF0000X | AP114985 | TX | Y | Physician Assistants & Advanced Practice Nursing Providers | Nurse Practitioner | Family |
No ID Information.