Provider Demographics
NPI:1205206174
Name:ROE, CHRISTINE DENISON (NP)
Entity Type:Individual
Prefix:MRS
First Name:CHRISTINE
Middle Name:DENISON
Last Name:ROE
Suffix:
Gender:F
Credentials:NP
Other - Prefix:
Other - First Name:
Other - Middle Name:
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Other - Credentials:
Mailing Address - Street 1:449 ROUTE 146 STE 101
Mailing Address - Street 2:
Mailing Address - City:HALFMOON
Mailing Address - State:NY
Mailing Address - Zip Code:12065-3239
Mailing Address - Country:US
Mailing Address - Phone:518-373-3924
Mailing Address - Fax:518-373-3808
Practice Address - Street 1:3 CROSSINGS BLVD
Practice Address - Street 2:SUITE ONE
Practice Address - City:CLIFTON PARK
Practice Address - State:NY
Practice Address - Zip Code:12065
Practice Address - Country:US
Practice Address - Phone:518-831-4434
Practice Address - Fax:518-831-4439
Is Sole Proprietor?:No
Enumeration Date:2015-10-04
Last Update Date:2020-08-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAAP60565547363LF0000X
NY338753363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA1205206174Medicaid
WA8946903Medicare PIN