Provider Demographics
NPI:1083839856
Name:WASILEWSKI, CHRISTINE LINDA (APRN-C)
Entity Type:Individual
Prefix:MRS
First Name:CHRISTINE
Middle Name:LINDA
Last Name:WASILEWSKI
Suffix:
Gender:F
Credentials:APRN-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6106 BROOKMERE PL
Mailing Address - Street 2:
Mailing Address - City:MABLETON
Mailing Address - State:GA
Mailing Address - Zip Code:30126-2787
Mailing Address - Country:US
Mailing Address - Phone:770-739-6314
Mailing Address - Fax:
Practice Address - Street 1:3903 S COBB DR SE
Practice Address - Street 2:
Practice Address - City:SMYRNA
Practice Address - State:GA
Practice Address - Zip Code:30080-6342
Practice Address - Country:US
Practice Address - Phone:770-434-1904
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-04-16
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GARN131213363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
GAP55399001Medicare UPIN
GA50BBFWMMedicare ID - Type Unspecified