Provider Demographics
NPI:1871984096
Name:IDICULA, CHRISTI
Entity type:Individual
Prefix:
First Name:CHRISTI
Middle Name:
Last Name:IDICULA
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1125 DAMSEL CAROLINE DR
Mailing Address - Street 2:
Mailing Address - City:LEWISVILLE
Mailing Address - State:TX
Mailing Address - Zip Code:75056-5779
Mailing Address - Country:US
Mailing Address - Phone:972-571-3299
Mailing Address - Fax:
Practice Address - Street 1:1125 DAMSEL CAROLINE DR
Practice Address - Street 2:
Practice Address - City:LEWISVILLE
Practice Address - State:TX
Practice Address - Zip Code:75056-5779
Practice Address - Country:US
Practice Address - Phone:972-571-3299
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2015-02-10
Last Update Date:2015-02-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXAP127431367500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367500000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Anesthetist, Certified Registered