Basic Information
Provider Information
NPI: 1609411651
EntityType: 1
ReplacementNPI:  
OrganizationName:  
LastName: NUNEZ
FirstName: CHRISTINA
MiddleName: A
NamePrefix:  
NameSuffix:  
Credential: NP
OtherOrganizationName:  
OtherOrganizationType:  
OtherLastName:  
OtherFirstName:  
OtherMiddleName:  
OtherNamePrefix:  
OtherNameSuffix:  
OtherCredential:  
OtherLastNameType:  
Mailing Information
Address1: 1509 DULLES DR
Address2:  
City: LAFAYETTE
State: LA
PostalCode: 705063718
CountryCode: US
TelephoneNumber: 3379919276
FaxNumber: 3379430846
Practice Location
Address1: 6801 E RIVERSIDE DR
Address2:  
City: AUSTIN
State: TX
PostalCode: 787416633
CountryCode: US
TelephoneNumber: 5122479000
FaxNumber:  
Other Information
ProviderEnumerationDate: 11/14/2019
LastUpdateDate: 11/14/2019
NPIDeactivationReasonCode:  
NPIDeactivationDate:  
NPIReactivationDate:  
ProviderGenderCode: F
AuthorizedOfficialLastName:  
AuthorizedOfficialFirstName:  
AuthorizedOfficialMiddleName:  
AuthorizedOfficialTitleorPosition:  
AuthorizedOfficialTelephone:  
IsSoleProprietor: N
IsOrganizationSubpart:  
ParentOrganizationLBN:  
AuthorizedOfficialNamePrefix:  
AuthorizedOfficialNameSuffix:  
AuthorizedOfficialCredential:  
NPICertificationDate:  

Taxonomy Information
TaxonomyLicenseStateSwitchTaxonomyGroupTaxonomyTypeTaxonomyClassSubSpecialty
363LF0000XAP142661TXY Physician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily

No ID Information.


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