Provider Demographics
NPI:1073546016
Name:ABT, CHRISTINE MARGARET (APN, CS)
Entity Type:Individual
Prefix:MS
First Name:CHRISTINE
Middle Name:MARGARET
Last Name:ABT
Suffix:
Gender:F
Credentials:APN, CS
Other - Prefix:
Other - First Name:CHRISTINE
Other - Middle Name:MARGARET
Other - Last Name:HAACK
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:APN, CS
Mailing Address - Street 1:385 WIRTZ RD
Mailing Address - Street 2:HEALTH SERVICES
Mailing Address - City:DEKALB
Mailing Address - State:IL
Mailing Address - Zip Code:60115
Mailing Address - Country:US
Mailing Address - Phone:815-753-1311
Mailing Address - Fax:
Practice Address - Street 1:ADVANCE PSYCHIATRY AND COUNSELING
Practice Address - Street 2:BILLING DEPT. 5973
Practice Address - City:CAROL STREAM
Practice Address - State:IL
Practice Address - Zip Code:60122-0001
Practice Address - Country:US
Practice Address - Phone:630-855-2614
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-07-09
Last Update Date:2015-04-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL209-004215364SP0812X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes364SP0812XPhysician Assistants & Advanced Practice Nursing ProvidersClinical Nurse SpecialistPsychiatric/Mental Health, Community
Provider Identifiers
StateIdentifier IDID TypeIssuer
ILP90908Medicare UPIN
IL206004Medicare ID - Type UnspecifiedMEDICARE #