Provider Demographics
NPI:1114300381
Name:FRIEDERICH, CHRISTIN PAGE (WHNP-BC)
Entity Type:Individual
Prefix:
First Name:CHRISTIN
Middle Name:PAGE
Last Name:FRIEDERICH
Suffix:
Gender:F
Credentials:WHNP-BC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2016 VADALABENE DR STE B
Mailing Address - Street 2:
Mailing Address - City:MARYVILLE
Mailing Address - State:IL
Mailing Address - Zip Code:62062-6901
Mailing Address - Country:US
Mailing Address - Phone:618-288-2987
Mailing Address - Fax:618-288-3572
Practice Address - Street 1:2016 VADALABENE DR STE B
Practice Address - Street 2:
Practice Address - City:MARYVILLE
Practice Address - State:IL
Practice Address - Zip Code:62062-6901
Practice Address - Country:US
Practice Address - Phone:618-288-2970
Practice Address - Fax:618-288-3572
Is Sole Proprietor?:No
Enumeration Date:2015-07-06
Last Update Date:2021-06-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL209012321363LX0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363LX0001XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerObstetrics & GynecologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL309014755OtherCONTROLLED SUBSTANCE LICENSE NUMBER
IL209012321OtherSTATE LICENSE NUMBER