Provider Demographics
NPI:1073283677
Name:ROSTKOWSKI, CHRISTINE DENISE
Entity Type:Individual
Prefix:
First Name:CHRISTINE
Middle Name:DENISE
Last Name:ROSTKOWSKI
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 1:11307 CORA LN
Mailing Address - Street 2:
Mailing Address - City:WILLIS
Mailing Address - State:TX
Mailing Address - Zip Code:77318-1115
Mailing Address - Country:US
Mailing Address - Phone:832-589-7122
Mailing Address - Fax:
Practice Address - Street 1:1695 S VOSS RD
Practice Address - Street 2:
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77057-2622
Practice Address - Country:US
Practice Address - Phone:832-917-0636
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-09-15
Last Update Date:2023-02-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX1054563363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily