Provider Demographics
NPI:1073154423
Name:MOOSE, CHRISTINA HERMAN (NP-C)
Entity Type:Individual
Prefix:MRS
First Name:CHRISTINA
Middle Name:HERMAN
Last Name:MOOSE
Suffix:
Gender:F
Credentials:NP-C
Other - Prefix:
Other - First Name:CHRISTINA
Other - Middle Name:RAYE
Other - Last Name:MOOSE
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:NP-C
Mailing Address - Street 1:PO BOX 60447
Mailing Address - Street 2:
Mailing Address - City:CHARLOTTE
Mailing Address - State:NC
Mailing Address - Zip Code:28260-0447
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:860 JAKE ALEXANDER BLVD W
Practice Address - Street 2:
Practice Address - City:SALISBURY
Practice Address - State:NC
Practice Address - Zip Code:28147-1220
Practice Address - Country:US
Practice Address - Phone:704-637-7590
Practice Address - Fax:704-316-1880
Is Sole Proprietor?:No
Enumeration Date:2019-10-07
Last Update Date:2023-08-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC5012387363L00000X
NC211011163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
No163W00000XNursing Service ProvidersRegistered Nurse