Provider Demographics
NPI:1043652381
Name:VAN NORMAN, CHRISTINA MARIE (LAC)
Entity Type:Individual
Prefix:
First Name:CHRISTINA
Middle Name:MARIE
Last Name:VAN NORMAN
Suffix:
Gender:F
Credentials:LAC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:24724 HIPSLEY MILL RD
Mailing Address - Street 2:
Mailing Address - City:LAYTONSVILLE
Mailing Address - State:MD
Mailing Address - Zip Code:20882-3140
Mailing Address - Country:US
Mailing Address - Phone:301-482-0953
Mailing Address - Fax:
Practice Address - Street 1:24724 HIPSLEY MILL RD
Practice Address - Street 2:
Practice Address - City:LAYTONSVILLE
Practice Address - State:MD
Practice Address - Zip Code:20882-3140
Practice Address - Country:US
Practice Address - Phone:301-482-0953
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-07-29
Last Update Date:2013-07-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDU02038171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist