Provider Demographics
NPI:1053190777
Name:REDDING, CHRISTINA M (LPN)
Entity type:Individual
Prefix:
First Name:CHRISTINA
Middle Name:M
Last Name:REDDING
Suffix:
Gender:F
Credentials:LPN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2465 BONADENT DR STE 3
Mailing Address - Street 2:
Mailing Address - City:WATERLOO
Mailing Address - State:NY
Mailing Address - Zip Code:13165-4111
Mailing Address - Country:US
Mailing Address - Phone:315-539-1920
Mailing Address - Fax:
Practice Address - Street 1:2465 BONADENT DR STE 3
Practice Address - Street 2:
Practice Address - City:WATERLOO
Practice Address - State:NY
Practice Address - Zip Code:13165-4111
Practice Address - Country:US
Practice Address - Phone:315-539-1920
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-09-22
Last Update Date:2023-09-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY258249164W00000X
252Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes252Y00000XAgenciesEarly Intervention Provider Agency
No164W00000XNursing Service ProvidersLicensed Practical Nurse