Provider Demographics
NPI:1013564905
Name:VARDHAMI, CHRISTIE LEE (APRN)
Entity Type:Individual
Prefix:
First Name:CHRISTIE
Middle Name:LEE
Last Name:VARDHAMI
Suffix:
Gender:F
Credentials:APRN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:420 N MAIN ST
Mailing Address - Street 2:
Mailing Address - City:BRISTOL
Mailing Address - State:CT
Mailing Address - Zip Code:06010-4923
Mailing Address - Country:US
Mailing Address - Phone:860-583-5858
Mailing Address - Fax:860-584-9962
Practice Address - Street 1:420 N MAIN ST
Practice Address - Street 2:
Practice Address - City:BRISTOL
Practice Address - State:CT
Practice Address - Zip Code:06010-4923
Practice Address - Country:US
Practice Address - Phone:860-583-5858
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-08-24
Last Update Date:2021-11-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT8433363LP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health