Provider Demographics
NPI:1346722295
Name:ST. OURS, CHRISTINE LOUISE (MS, RN, LDN, CNS)
Entity Type:Individual
Prefix:
First Name:CHRISTINE
Middle Name:LOUISE
Last Name:ST. OURS
Suffix:
Gender:F
Credentials:MS, RN, LDN, CNS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:DUNDALK PEDIATRIC ASSOCIATES
Mailing Address - Street 2:1792 MERRITT BLVD.
Mailing Address - City:DUNDALK
Mailing Address - State:MD
Mailing Address - Zip Code:21222
Mailing Address - Country:US
Mailing Address - Phone:410-284-1133
Mailing Address - Fax:
Practice Address - Street 1:DUNDALK PEDIATRIC ASSOCIATES
Practice Address - Street 2:1792 MERRITT BLVD.
Practice Address - City:DUNDALK
Practice Address - State:MD
Practice Address - Zip Code:21222-2122
Practice Address - Country:US
Practice Address - Phone:410-284-1133
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-09-06
Last Update Date:2018-09-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDDX4486133N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133N00000XDietary & Nutritional Service ProvidersNutritionist