Provider Demographics
NPI:1376663633
Name:MANDERS, CHRISTINA J (DO)
Entity Type:Individual
Prefix:
First Name:CHRISTINA
Middle Name:J
Last Name:MANDERS
Suffix:
Gender:F
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5725 LOFTUS LANE
Mailing Address - Street 2:
Mailing Address - City:SAVAGE
Mailing Address - State:MN
Mailing Address - Zip Code:55378-2717
Mailing Address - Country:US
Mailing Address - Phone:952-226-2500
Mailing Address - Fax:952-226-9501
Practice Address - Street 1:5725 LOFTUS LANE
Practice Address - Street 2:
Practice Address - City:SAVAGE
Practice Address - State:MN
Practice Address - Zip Code:55378-2717
Practice Address - Country:US
Practice Address - Phone:952-226-2500
Practice Address - Fax:952-226-2501
Is Sole Proprietor?:No
Enumeration Date:2007-03-30
Last Update Date:2012-03-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN49798207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
MN926640000Medicaid
MN926640000Medicaid