Provider Demographics
NPI:1124254842
Name:BACKERT, CHRISTEL N (FNP)
Entity type:Individual
Prefix:
First Name:CHRISTEL
Middle Name:N
Last Name:BACKERT
Suffix:
Gender:F
Credentials:FNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:15810 S. HARLAND ROAD STE B
Mailing Address - Street 2:
Mailing Address - City:LATHROP
Mailing Address - State:CA
Mailing Address - Zip Code:95330-9476
Mailing Address - Country:US
Mailing Address - Phone:209-229-4455
Mailing Address - Fax:209-215-0285
Practice Address - Street 1:15810 S. HARLAND ROAD STE B
Practice Address - Street 2:
Practice Address - City:LATHROP
Practice Address - State:CA
Practice Address - Zip Code:95330-9476
Practice Address - Country:US
Practice Address - Phone:209-229-4455
Practice Address - Fax:209-215-0285
Is Sole Proprietor?:Yes
Enumeration Date:2009-06-09
Last Update Date:2025-07-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA18958363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner