Provider Demographics
NPI:1083393482
Name:VAN WIE, CHRISTINE ANNE (STUDENT NP)
Entity Type:Individual
Prefix:
First Name:CHRISTINE
Middle Name:ANNE
Last Name:VAN WIE
Suffix:
Gender:F
Credentials:STUDENT NP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:300 FENWAY
Mailing Address - Street 2:
Mailing Address - City:BOSTON
Mailing Address - State:MA
Mailing Address - Zip Code:02115-5820
Mailing Address - Country:US
Mailing Address - Phone:503-270-0184
Mailing Address - Fax:
Practice Address - Street 1:300 FENWAY
Practice Address - Street 2:
Practice Address - City:BOSTON
Practice Address - State:MA
Practice Address - Zip Code:02115-5820
Practice Address - Country:US
Practice Address - Phone:855-465-7466
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-07-13
Last Update Date:2023-07-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program