Basic Information
| Provider Information | |||||||||
| NPI: | 1629478581 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | SLAGLE | ||||||||
| FirstName: | CHRISTA | ||||||||
| MiddleName: | |||||||||
| NamePrefix: | |||||||||
| NameSuffix: | |||||||||
| Credential: | APRN, FNP-BC | ||||||||
| OtherOrganizationName: | |||||||||
| OtherOrganizationType: | |||||||||
| OtherLastName: | HOSKEY | ||||||||
| OtherFirstName: | CHRISTA | ||||||||
| OtherMiddleName: | |||||||||
| OtherNamePrefix: | |||||||||
| OtherNameSuffix: | |||||||||
| OtherCredential: | APRN, FNP-BC | ||||||||
| OtherLastNameType: | 5 | ||||||||
| Mailing Information | |||||||||
| Address1: | 402 SIEGEL ST | ||||||||
| Address2: | |||||||||
| City: | TAMA | ||||||||
| State: | IA | ||||||||
| PostalCode: | 523392302 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6202751766 | ||||||||
| FaxNumber: | 6202754729 | ||||||||
| Practice Location | |||||||||
| Address1: | 402 SIEGEL ST | ||||||||
| Address2: | |||||||||
| City: | TAMA | ||||||||
| State: | IA | ||||||||
| PostalCode: | 523392302 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6202751766 | ||||||||
| FaxNumber: | 6202754729 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 08/28/2014 | ||||||||
| LastUpdateDate: | 02/04/2015 | ||||||||
| NPIDeactivationReasonCode: | |||||||||
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| NPIReactivationDate: | |||||||||
| ProviderGenderCode: | F | ||||||||
| AuthorizedOfficialLastName: | |||||||||
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| AuthorizedOfficialMiddleName: | |||||||||
| AuthorizedOfficialTitleorPosition: | |||||||||
| AuthorizedOfficialTelephone: | |||||||||
| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | |||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 163W00000X | 14-128673 | KS | N | Nursing Service Providers | Registered Nurse | 163W00000X | 126378 | IA | N | Nursing Service Providers | Registered Nurse | 363LF0000X | 53-76444 | KS | Y | Physician Assistants & Advanced Practice Nursing Providers | Nurse Practitioner | Family |
No ID Information.