Provider Demographics
NPI:1003242314
Name:EARLE, CHRISTOPHER IAN (DNP)
Entity type:Individual
Prefix:MR
First Name:CHRISTOPHER
Middle Name:IAN
Last Name:EARLE
Suffix:
Gender:M
Credentials:DNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1835 E 6TH ST
Mailing Address - Street 2:STE 21
Mailing Address - City:TEMPE
Mailing Address - State:AZ
Mailing Address - Zip Code:85281-2964
Mailing Address - Country:US
Mailing Address - Phone:480-581-6981
Mailing Address - Fax:949-655-7895
Practice Address - Street 1:1835 E 6TH ST
Practice Address - Street 2:STE 21
Practice Address - City:TEMPE
Practice Address - State:AZ
Practice Address - Zip Code:85281-2964
Practice Address - Country:US
Practice Address - Phone:480-581-6981
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2013-09-18
Last Update Date:2020-07-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZAP5159363LP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZ848051Medicaid
AZZ182427Medicare PIN