Provider Demographics
NPI:1144864778
Name:AVERHART, CHRISTINA (LMT, LPN, CLC, LLP)
Entity type:Individual
Prefix:
First Name:CHRISTINA
Middle Name:
Last Name:AVERHART
Suffix:
Gender:F
Credentials:LMT, LPN, CLC, LLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4336 BENTGRASS MDWS NE
Mailing Address - Street 2:
Mailing Address - City:RIO RANCHO
Mailing Address - State:NM
Mailing Address - Zip Code:87144-5686
Mailing Address - Country:US
Mailing Address - Phone:850-603-1806
Mailing Address - Fax:
Practice Address - Street 1:6739 ACADEMY RD NE STE 250
Practice Address - Street 2:
Practice Address - City:ALBUQUERQUE
Practice Address - State:NM
Practice Address - Zip Code:87109-3357
Practice Address - Country:US
Practice Address - Phone:850-603-1806
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-11-06
Last Update Date:2019-11-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NMLPN-23460164W00000X
NMMT9150225700000X
FLMA51432225700000X
NM55425174N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174N00000XOther Service ProvidersLactation Consultant, Non-RN
No164W00000XNursing Service ProvidersLicensed Practical Nurse
No225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist