Provider Demographics
NPI:1366761272
Name:DALTON, CHRISTINE N (NP)
Entity type:Individual
Prefix:
First Name:CHRISTINE
Middle Name:N
Last Name:DALTON
Suffix:
Gender:F
Credentials:NP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:200 MED TECH PKWY
Mailing Address - Street 2:SUITE 108
Mailing Address - City:JOHNSON CITY
Mailing Address - State:TN
Mailing Address - Zip Code:37604-2278
Mailing Address - Country:US
Mailing Address - Phone:423-915-5033
Mailing Address - Fax:423-915-5179
Practice Address - Street 1:200 MED TECH PKWY
Practice Address - Street 2:SUITE 108
Practice Address - City:JOHNSON CITY
Practice Address - State:TN
Practice Address - Zip Code:37604-2278
Practice Address - Country:US
Practice Address - Phone:423-915-5033
Practice Address - Fax:423-915-5179
Is Sole Proprietor?:No
Enumeration Date:2010-05-18
Last Update Date:2010-05-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN158754363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner