Provider Demographics
NPI:1326761669
Name:ANDERSON, CHRISTINE L (LPN)
Entity Type:Individual
Prefix:MRS
First Name:CHRISTINE
Middle Name:L
Last Name:ANDERSON
Suffix:
Gender:F
Credentials:LPN
Other - Prefix:
Other - First Name:CHRISTINE
Other - Middle Name:L
Other - Last Name:ANDERSON
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:LPN
Mailing Address - Street 1:174 BABCOCK LN
Mailing Address - Street 2:
Mailing Address - City:CENTRALIA
Mailing Address - State:WA
Mailing Address - Zip Code:98531-5609
Mailing Address - Country:US
Mailing Address - Phone:503-679-8376
Mailing Address - Fax:
Practice Address - Street 1:1060 SW 20TH ST
Practice Address - Street 2:
Practice Address - City:CHEHALIS
Practice Address - State:WA
Practice Address - Zip Code:98532-4210
Practice Address - Country:US
Practice Address - Phone:360-807-7200
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-09-21
Last Update Date:2022-09-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WA60764592164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse