Basic Information
Provider Information
NPI: 1114355435
EntityType: 1
ReplacementNPI:  
OrganizationName:  
LastName: SZABO
FirstName: CHRISTA
MiddleName: LAUREN
NamePrefix:  
NameSuffix:  
Credential: CPNP
OtherOrganizationName:  
OtherOrganizationType:  
OtherLastName:  
OtherFirstName:  
OtherMiddleName:  
OtherNamePrefix:  
OtherNameSuffix:  
OtherCredential:  
OtherLastNameType:  
Mailing Information
Address1: 1825 MARTHA BERRY BLVD NW
Address2:  
City: ROME
State: GA
PostalCode: 301651625
CountryCode: US
TelephoneNumber: 7062955331
FaxNumber:  
Practice Location
Address1: 1013 N 5TH AVE NE
Address2:  
City: ROME
State: GA
PostalCode: 301652664
CountryCode: US
TelephoneNumber: 7062349992
FaxNumber: 7062349026
Other Information
ProviderEnumerationDate: 10/23/2013
LastUpdateDate: 10/23/2013
NPIDeactivationReasonCode:  
NPIDeactivationDate:  
NPIReactivationDate:  
ProviderGenderCode: F
AuthorizedOfficialLastName:  
AuthorizedOfficialFirstName:  
AuthorizedOfficialMiddleName:  
AuthorizedOfficialTitleorPosition:  
AuthorizedOfficialTelephone:  
IsSoleProprietor: N
IsOrganizationSubpart:  
ParentOrganizationLBN:  
AuthorizedOfficialNamePrefix:  
AuthorizedOfficialNameSuffix:  
AuthorizedOfficialCredential:  
NPICertificationDate:  

Taxonomy Information
TaxonomyLicenseStateSwitchTaxonomyGroupTaxonomyTypeTaxonomyClassSubSpecialty
363L00000XRN233644GAY Physician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner 

No ID Information.


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