Provider Demographics
NPI:1336684729
Name:KLAM, CHRISTINE (NP)
Entity Type:Individual
Prefix:
First Name:CHRISTINE
Middle Name:
Last Name:KLAM
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 1:25125 SWEETSPIRE SQ
Mailing Address - Street 2:
Mailing Address - City:ALDIE
Mailing Address - State:VA
Mailing Address - Zip Code:20105-5631
Mailing Address - Country:US
Mailing Address - Phone:703-618-4478
Mailing Address - Fax:
Practice Address - Street 1:19490 SANDRIDGE WAY STE 350
Practice Address - Street 2:
Practice Address - City:LEESBURG
Practice Address - State:VA
Practice Address - Zip Code:20176-3467
Practice Address - Country:US
Practice Address - Phone:703-858-5599
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2016-12-21
Last Update Date:2018-05-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0024173878363LW0102X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LW0102XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerWomen's Health