Provider Demographics
NPI:1053440800
Name:CHRISTIAN, DONNA MARIE (APN)
Entity Type:Individual
Prefix:MS
First Name:DONNA
Middle Name:MARIE
Last Name:CHRISTIAN
Suffix:
Gender:F
Credentials:APN
Other - Prefix:MS
Other - First Name:DONNA
Other - Middle Name:MARIE
Other - Last Name:DUCKWILEY
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:APN
Mailing Address - Street 1:4546 S. INDIANA UNIT 1 NORTH
Mailing Address - Street 2:
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60653
Mailing Address - Country:US
Mailing Address - Phone:773-702-2869
Mailing Address - Fax:773-536-2250
Practice Address - Street 1:5841 S MARYLAND AVE
Practice Address - Street 2:MC 9036
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60637-1447
Practice Address - Country:US
Practice Address - Phone:773-702-2869
Practice Address - Fax:773-536-2250
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-05
Last Update Date:2008-08-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL209001680363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
ILP39236Medicare UPIN