Provider Demographics
NPI:1083145148
Name:DEBOER-COLLINS, CHRISTINA R (DO)
Entity Type:Individual
Prefix:
First Name:CHRISTINA
Middle Name:R
Last Name:DEBOER-COLLINS
Suffix:
Gender:F
Credentials:DO
Other - Prefix:
Other - First Name:CHRISTINA
Other - Middle Name:
Other - Last Name:DEBOER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:1836 SOUTH AVE
Mailing Address - Street 2:
Mailing Address - City:LA CROSSE
Mailing Address - State:WI
Mailing Address - Zip Code:54601-5429
Mailing Address - Country:US
Mailing Address - Phone:608-782-7300
Mailing Address - Fax:
Practice Address - Street 1:1111 W WISCONSIN ST
Practice Address - Street 2:
Practice Address - City:SPARTA
Practice Address - State:WI
Practice Address - Zip Code:54656-2233
Practice Address - Country:US
Practice Address - Phone:608-269-6735
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-03-21
Last Update Date:2022-11-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI76760207Q00000X
MI5151012415207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine