Basic Information
Provider Information | |||||||||
NPI: | 1568435923 | ||||||||
EntityType: | 1 | ||||||||
ReplacementNPI: |   | ||||||||
OrganizationName: |   | ||||||||
LastName: | NORDLING | ||||||||
FirstName: | CHRISTINE | ||||||||
MiddleName: | MAE | ||||||||
NamePrefix: |   | ||||||||
NameSuffix: |   | ||||||||
Credential: | MD | ||||||||
OtherOrganizationName: |   | ||||||||
OtherOrganizationType: |   | ||||||||
OtherLastName: | TURUNEN | ||||||||
OtherFirstName: | CHRISTINE | ||||||||
OtherMiddleName: | MAE | ||||||||
OtherNamePrefix: |   | ||||||||
OtherNameSuffix: |   | ||||||||
OtherCredential: | MD | ||||||||
OtherLastNameType: | 1 | ||||||||
Mailing Information | |||||||||
Address1: | 8881 FLETCHER PKWY STE 105 | ||||||||
Address2: |   | ||||||||
City: | LA MESA | ||||||||
State: | CA | ||||||||
PostalCode: | 919423132 | ||||||||
CountryCode: | US | ||||||||
TelephoneNumber: | 8584992600 | ||||||||
FaxNumber: | 6194623064 | ||||||||
Practice Location | |||||||||
Address1: | 8881 FLETCHER PKWY STE 105 | ||||||||
Address2: |   | ||||||||
City: | LA MESA | ||||||||
State: | CA | ||||||||
PostalCode: | 919423132 | ||||||||
CountryCode: | US | ||||||||
TelephoneNumber: | 8584992600 | ||||||||
FaxNumber: | 6194623064 | ||||||||
Other Information | |||||||||
ProviderEnumerationDate: | 02/08/2006 | ||||||||
LastUpdateDate: | 06/25/2013 | ||||||||
NPIDeactivationReasonCode: |   | ||||||||
NPIDeactivationDate: |   | ||||||||
NPIReactivationDate: |   | ||||||||
ProviderGenderCode: | F | ||||||||
AuthorizedOfficialLastName: |   | ||||||||
AuthorizedOfficialFirstName: |   | ||||||||
AuthorizedOfficialMiddleName: |   | ||||||||
AuthorizedOfficialTitleorPosition: |   | ||||||||
AuthorizedOfficialTelephone: |   | ||||||||
IsSoleProprietor: | N | ||||||||
IsOrganizationSubpart: |   | ||||||||
ParentOrganizationLBN: |   | ||||||||
AuthorizedOfficialNamePrefix: |   | ||||||||
AuthorizedOfficialNameSuffix: |   | ||||||||
AuthorizedOfficialCredential: |   | ||||||||
NPICertificationDate: |   |
Taxonomy Information
Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207Q00000X | G71174 | CO | Y |   | Allopathic & Osteopathic Physicians | Family Medicine |   |
ID Information
ID | Type | State | Issuer | Description | ZZZ36915Z | 05 | CA |   | MEDICAID |