Provider Demographics
NPI:1275130288
Name:MCVAN, CHRISTINE WALTER (NP)
Entity Type:Individual
Prefix:
First Name:CHRISTINE
Middle Name:WALTER
Last Name:MCVAN
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 1:509 GERMANTOWN PIKE
Mailing Address - Street 2:
Mailing Address - City:LAFAYETTE HILL
Mailing Address - State:PA
Mailing Address - Zip Code:19444-1825
Mailing Address - Country:US
Mailing Address - Phone:610-828-7570
Mailing Address - Fax:
Practice Address - Street 1:509 GERMANTOWN PIKE
Practice Address - Street 2:
Practice Address - City:LAFAYETTE HILL
Practice Address - State:PA
Practice Address - Zip Code:19444-1825
Practice Address - Country:US
Practice Address - Phone:610-828-7570
Practice Address - Fax:610-941-3915
Is Sole Proprietor?:No
Enumeration Date:2020-10-02
Last Update Date:2024-02-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PASP022614363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily