Provider Demographics
NPI:1750781753
Name:MORALES, CHRISTINA GAIL (APRN)
Entity type:Individual
Prefix:
First Name:CHRISTINA
Middle Name:GAIL
Last Name:MORALES
Suffix:
Gender:F
Credentials:APRN
Other - Prefix:
Other - First Name:CHRISTINA
Other - Middle Name:
Other - Last Name:MORALES
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:APRN
Mailing Address - Street 1:PO BOX 35380
Mailing Address - Street 2:
Mailing Address - City:LAS VEGAS
Mailing Address - State:NV
Mailing Address - Zip Code:89133-5380
Mailing Address - Country:US
Mailing Address - Phone:702-877-5199
Mailing Address - Fax:
Practice Address - Street 1:8526 DEL WEBB BLVD
Practice Address - Street 2:
Practice Address - City:LAS VEGAS
Practice Address - State:NV
Practice Address - Zip Code:89134-8676
Practice Address - Country:US
Practice Address - Phone:702-877-5199
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2014-08-26
Last Update Date:2019-12-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT8026134-4405363L00000X
UT8026134-8900363LF0000X
NV823312363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
No363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
UTEFF: 4/2/15Medicaid
UT1750781753-4/27/15Medicaid
UTU000090523Medicare PIN
UTU000090523-4/27/2015Medicare PIN