Provider Demographics
NPI:1043097959
Name:VAN, CHRISTINE S
Entity Type:Individual
Prefix:
First Name:CHRISTINE
Middle Name:S
Last Name:VAN
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2031 MICHIGAN AVE
Mailing Address - Street 2:
Mailing Address - City:ALMA
Mailing Address - State:MI
Mailing Address - Zip Code:48801-9703
Mailing Address - Country:US
Mailing Address - Phone:989-423-7715
Mailing Address - Fax:
Practice Address - Street 1:2031 MICHIGAN AVE
Practice Address - Street 2:
Practice Address - City:ALMA
Practice Address - State:MI
Practice Address - Zip Code:48801-9703
Practice Address - Country:US
Practice Address - Phone:989-423-7715
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-09-13
Last Update Date:2023-09-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes172V00000XOther Service ProvidersCommunity Health WorkerGroup - Single Specialty