Provider Demographics
NPI:1083687040
Name:NORDICK, CHRISTINA LEONE (NP)
Entity Type:Individual
Prefix:DR
First Name:CHRISTINA
Middle Name:LEONE
Last Name:NORDICK
Suffix:
Gender:F
Credentials:NP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2200 52ND AVE
Mailing Address - Street 2:
Mailing Address - City:MOLINE
Mailing Address - State:IL
Mailing Address - Zip Code:61265-6308
Mailing Address - Country:US
Mailing Address - Phone:309-797-2900
Mailing Address - Fax:214-730-9797
Practice Address - Street 1:2200 52ND AVE
Practice Address - Street 2:
Practice Address - City:MOLINE
Practice Address - State:IL
Practice Address - Zip Code:61265-6308
Practice Address - Country:US
Practice Address - Phone:309-797-2900
Practice Address - Fax:309-797-2147
Is Sole Proprietor?:No
Enumeration Date:2006-02-09
Last Update Date:2021-12-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL041279291163W00000X
IL209004461363L00000X
IL277001629363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
No163W00000XNursing Service ProvidersRegistered Nurse
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL277001629OtherFPA-APRN
P75099Medicare UPIN