Provider Demographics
NPI:1235890047
Name:ST DENIS, CHRISTINA (RN)
Entity Type:Individual
Prefix:
First Name:CHRISTINA
Middle Name:
Last Name:ST DENIS
Suffix:
Gender:F
Credentials:RN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:26 CHAMPLAIN DR
Mailing Address - Street 2:
Mailing Address - City:MINEVILLE
Mailing Address - State:NY
Mailing Address - Zip Code:12956-1061
Mailing Address - Country:US
Mailing Address - Phone:518-570-7399
Mailing Address - Fax:
Practice Address - Street 1:50 MONTCALM ST
Practice Address - Street 2:
Practice Address - City:TICONDEROGA
Practice Address - State:NY
Practice Address - Zip Code:12883-1393
Practice Address - Country:US
Practice Address - Phone:518-585-7934
Practice Address - Fax:518-585-7934
Is Sole Proprietor?:No
Enumeration Date:2022-01-04
Last Update Date:2022-01-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY633879163WA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WA0400XNursing Service ProvidersRegistered NurseAddiction (Substance Use Disorder)