Provider Demographics
NPI:1609602192
Name:FLYTE, CHRISTINA MARIE (LPN)
Entity type:Individual
Prefix:MRS
First Name:CHRISTINA
Middle Name:MARIE
Last Name:FLYTE
Suffix:
Gender:F
Credentials:LPN
Other - Prefix:
Other - First Name:CHRTINA
Other - Middle Name:MARIE
Other - Last Name:SMITH
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:230 HAWTHORN LANE
Mailing Address - Street 2:
Mailing Address - City:KUNKLETOWN
Mailing Address - State:PA
Mailing Address - Zip Code:18058
Mailing Address - Country:US
Mailing Address - Phone:610-674-5073
Mailing Address - Fax:
Practice Address - Street 1:230 HAWTHORN LANE
Practice Address - Street 2:
Practice Address - City:KUNKLETOWN
Practice Address - State:PA
Practice Address - Zip Code:18058
Practice Address - Country:US
Practice Address - Phone:610-674-5073
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-09-11
Last Update Date:2024-09-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAPN321040164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes164W00000XNursing Service ProvidersLicensed Practical NurseGroup - Single Specialty