Provider Demographics
NPI:1447028279
Name:CHRISTIAN, TERESA JO
Entity type:Individual
Prefix:
First Name:TERESA
Middle Name:JO
Last Name:CHRISTIAN
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:TERESA
Other - Middle Name:JO
Other - Last Name:WILLIAMS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:810 S XENIA DR APT H
Mailing Address - Street 2:
Mailing Address - City:ENON
Mailing Address - State:OH
Mailing Address - Zip Code:45323-1765
Mailing Address - Country:US
Mailing Address - Phone:937-613-9830
Mailing Address - Fax:
Practice Address - Street 1:810 S XENIA DR APT H
Practice Address - Street 2:
Practice Address - City:ENON
Practice Address - State:OH
Practice Address - Zip Code:45323-1765
Practice Address - Country:US
Practice Address - Phone:937-613-9830
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-12-12
Last Update Date:2024-11-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3747P1801XNursing Service Related ProvidersTechnicianPersonal Care Attendant
No376J00000XNursing Service Related ProvidersHomemaker