Provider Demographics
NPI:1003508649
Name:VASILIEV, CRISTIAN A (FNP)
Entity Type:Individual
Prefix:MR
First Name:CRISTIAN
Middle Name:A
Last Name:VASILIEV
Suffix:
Gender:M
Credentials:FNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 23400
Mailing Address - Street 2:744 SOUTH WEBSTER AVE
Mailing Address - City:GREEN BAY
Mailing Address - State:WI
Mailing Address - Zip Code:54305-3018
Mailing Address - Country:US
Mailing Address - Phone:920-433-7411
Mailing Address - Fax:
Practice Address - Street 1:923 ELIZA ST
Practice Address - Street 2:
Practice Address - City:GREEN BAY
Practice Address - State:WI
Practice Address - Zip Code:54301-3018
Practice Address - Country:US
Practice Address - Phone:920-965-4800
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-05-23
Last Update Date:2024-04-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI13994-33363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily