Basic Information
| Provider Information | |||||||||
| NPI: | 1508322413 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | LAMARRE | ||||||||
| FirstName: | CHRISTINA | ||||||||
| MiddleName: | M | ||||||||
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| Credential: | RSST | ||||||||
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| Mailing Information | |||||||||
| Address1: | 154 S RIPLEY BLVD | ||||||||
| Address2: | |||||||||
| City: | ALPENA | ||||||||
| State: | MI | ||||||||
| PostalCode: | 497073406 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9893566385 | ||||||||
| FaxNumber: | 9893564909 | ||||||||
| Practice Location | |||||||||
| Address1: | 154 S RIPLEY BLVD | ||||||||
| Address2: | |||||||||
| City: | ALPENA | ||||||||
| State: | MI | ||||||||
| PostalCode: | 497073406 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9893566385 | ||||||||
| FaxNumber: | 9893564909 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 02/15/2019 | ||||||||
| LastUpdateDate: | 02/15/2019 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | Y | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 171M00000X | 6803087021 | MI | Y | Other Service Providers | Case Manager/Care Coordinator |
No ID Information.