Provider Demographics
NPI:1134459589
Name:FULLINWIDER, CHRISTINA MARIE (MSN, WHCNP)
Entity Type:Individual
Prefix:MS
First Name:CHRISTINA
Middle Name:MARIE
Last Name:FULLINWIDER
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Gender:F
Credentials:MSN, WHCNP
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Mailing Address - Street 1:12639 OLD TESSON ROAD
Mailing Address - Street 2:STE 100
Mailing Address - City:ST. LOUIS
Mailing Address - State:MO
Mailing Address - Zip Code:63128
Mailing Address - Country:US
Mailing Address - Phone:816-781-7820
Mailing Address - Fax:816-792-0656
Practice Address - Street 1:2529 GLENN HENDREN DRIVE
Practice Address - Street 2:STE 200 E
Practice Address - City:LIBERTY
Practice Address - State:MO
Practice Address - Zip Code:64068
Practice Address - Country:US
Practice Address - Phone:816-781-7820
Practice Address - Fax:816-792-0656
Is Sole Proprietor?:No
Enumeration Date:2010-01-07
Last Update Date:2018-03-02
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Provider Licenses
StateLicense IDTaxonomies
MO139628363LW0102X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LW0102XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerWomen's Health