Provider Demographics
NPI:1053714006
Name:ANDERSON, CHRISTINE (NP-C)
Entity type:Individual
Prefix:
First Name:CHRISTINE
Middle Name:
Last Name:ANDERSON
Suffix:
Gender:F
Credentials:NP-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:315 TRENT DR
Mailing Address - Street 2:ROOM 100
Mailing Address - City:DURHAM
Mailing Address - State:NC
Mailing Address - Zip Code:27710-3038
Mailing Address - Country:US
Mailing Address - Phone:919-681-5961
Mailing Address - Fax:919-681-4637
Practice Address - Street 1:315 TRENT DR
Practice Address - Street 2:ROOM 100
Practice Address - City:DURHAM
Practice Address - State:NC
Practice Address - Zip Code:27710-3038
Practice Address - Country:US
Practice Address - Phone:919-681-5961
Practice Address - Fax:919-681-4637
Is Sole Proprietor?:No
Enumeration Date:2014-10-06
Last Update Date:2015-11-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC5007232363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner