Provider Demographics
NPI:1861526147
Name:SMITH, CHRISTINE LORRAINE (NCMMT, LMT)
Entity type:Individual
Prefix:MRS
First Name:CHRISTINE
Middle Name:LORRAINE
Last Name:SMITH
Suffix:
Gender:F
Credentials:NCMMT, LMT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4334 CASSIDY STREET
Mailing Address - Street 2:
Mailing Address - City:COLORADO SPRINGS
Mailing Address - State:CO
Mailing Address - Zip Code:80911
Mailing Address - Country:US
Mailing Address - Phone:719-205-6647
Mailing Address - Fax:
Practice Address - Street 1:4334 CASSIDY STREET
Practice Address - Street 2:#109
Practice Address - City:COLORADO SPRINGS
Practice Address - State:CO
Practice Address - Zip Code:80911-3203
Practice Address - Country:US
Practice Address - Phone:719-471-2755
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-16
Last Update Date:2019-12-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
174400000X
CONA00769155376K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes376K00000XNursing Service Related ProvidersNurse's Aide
No174400000XOther Service ProvidersSpecialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
CO130409OtherCITY LICENSE
CO75-3021795OtherEIN