Individual
MRS. CHRISTINE MARIE SLACK
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
LPN
Contact information
Practice address
3701 E BROADWAY AVE, APACHE JUNCTION, AZ 85219-9301
(480) 982-1110
(480) 288-0532
Mailing address
10470 E DUTCHMANS TRL, GOLD CANYON, AZ 85218-4916
(480) 983-2311
Taxonomy
Speciality
Code
Description
License number
State
164W00000X
Licensed Practical Nurse
Primary
LP040169
AZ
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
178915
AHCCCS
AZ
Enumeration date
02/26/2007
Last updated
07/08/2007
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