Provider Demographics
NPI:1104028943
Name:NETTEN, CHRISTINA JG (NP)
Entity Type:Individual
Prefix:
First Name:CHRISTINA
Middle Name:JG
Last Name:NETTEN
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 1:211 MAIN ST
Mailing Address - Street 2:
Mailing Address - City:WATERVILLE
Mailing Address - State:ME
Mailing Address - Zip Code:04901-6117
Mailing Address - Country:US
Mailing Address - Phone:207-877-3460
Mailing Address - Fax:207-877-3459
Practice Address - Street 1:211 MAIN ST
Practice Address - Street 2:
Practice Address - City:WATERVILLE
Practice Address - State:ME
Practice Address - Zip Code:04901-6117
Practice Address - Country:US
Practice Address - Phone:207-877-3460
Practice Address - Fax:207-877-3459
Is Sole Proprietor?:No
Enumeration Date:2007-06-04
Last Update Date:2012-10-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA2265442363L00000X
MEAP111046363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
Provider Identifiers
StateIdentifier IDID TypeIssuer
MA110086710AMedicaid
MA110086710AMedicaid
ME001784904Medicare PIN