Individual
CHRISTINA MARIA CARRILLO
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
CRNA
Contact information
Practice address
530 S JACKSON ST, LOUISVILLE, KY 40202-1675
(502) 852-5851
(502) 852-3762
Mailing address
PO BOX 909, LOUISVILLE, KY 40201-0909
(502) 588-0328
(502) 587-4784
Taxonomy
Speciality
Code
Description
License number
State
163W00000X
Registered Nurse
1128025
KY
367500000X
Certified Registered Nurse Anesthetist
Primary
3015771
KY
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
300047226
—
IN
05
—
7100718670
—
KY
Enumeration date
01/28/2021
Last updated
02/09/2021
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