Basic Information
| Provider Information | |||||||||
| NPI: | 1770921223 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | HARDCASTLE | ||||||||
| FirstName: | CHRISTINA | ||||||||
| MiddleName: | NICOLE | ||||||||
| NamePrefix: | MS. | ||||||||
| NameSuffix: | |||||||||
| Credential: | MD | ||||||||
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| Mailing Information | |||||||||
| Address1: | 22 RICHARD PLACE SW | ||||||||
| Address2: | SUITE #343 | ||||||||
| City: | CALGARY | ||||||||
| State: | ALBERTA | ||||||||
| PostalCode: | T3E 7N6 | ||||||||
| CountryCode: | CA | ||||||||
| TelephoneNumber: | 4036809090 | ||||||||
| FaxNumber: | |||||||||
| Practice Location | |||||||||
| Address1: | 4800 SAND POINT WAY NE | ||||||||
| Address2: | |||||||||
| City: | SEATTLE | ||||||||
| State: | WA | ||||||||
| PostalCode: | 98105 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2069873996 | ||||||||
| FaxNumber: | 2069873935 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 06/06/2013 | ||||||||
| LastUpdateDate: | 05/06/2014 | ||||||||
| NPIDeactivationReasonCode: | |||||||||
| NPIDeactivationDate: | 04/03/2014 | ||||||||
| NPIReactivationDate: | 05/06/2014 | ||||||||
| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 390200000X | Y | Student, Health Care | Student in an Organized Health Care Education/Training Program |
No ID Information.