Provider Demographics
NPI:1073541173
Name:DANIELSON, CHRISTINE LYNN (CPNP)
Entity Type:Individual
Prefix:MS
First Name:CHRISTINE
Middle Name:LYNN
Last Name:DANIELSON
Suffix:
Gender:F
Credentials:CPNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:111 MICHIGAN AVE NW
Mailing Address - Street 2:UROLOGY
Mailing Address - City:WASHINGTON
Mailing Address - State:DC
Mailing Address - Zip Code:20010-2916
Mailing Address - Country:US
Mailing Address - Phone:202-476-5042
Mailing Address - Fax:202-476-4739
Practice Address - Street 1:111 MICHIGAN AVE NW
Practice Address - Street 2:UROLOGY
Practice Address - City:WASHINGTON
Practice Address - State:DC
Practice Address - Zip Code:20010-2916
Practice Address - Country:US
Practice Address - Phone:202-476-5042
Practice Address - Fax:202-476-4739
Is Sole Proprietor?:No
Enumeration Date:2006-06-28
Last Update Date:2009-04-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
DCRN1015539363LP0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
NH30342786Medicaid
Q08160Medicare UPIN
NHNP4450Medicare ID - Type Unspecified