Provider Demographics
NPI:1407829542
Name:STEPHENSON, CHRISTINA E (FNP)
Entity Type:Individual
Prefix:
First Name:CHRISTINA
Middle Name:E
Last Name:STEPHENSON
Suffix:
Gender:F
Credentials:FNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 4127
Mailing Address - Street 2:ROANOKE FAMILY MEDICINE INC
Mailing Address - City:ROANOKE
Mailing Address - State:VA
Mailing Address - Zip Code:24015
Mailing Address - Country:US
Mailing Address - Phone:540-527-1198
Mailing Address - Fax:540-344-7154
Practice Address - Street 1:3390 COLONIAL AVE
Practice Address - Street 2:ROANOKE FAMILY MEDICINE INC
Practice Address - City:ROANOKE
Practice Address - State:VA
Practice Address - Zip Code:24018
Practice Address - Country:US
Practice Address - Phone:540-772-1006
Practice Address - Fax:540-772-1086
Is Sole Proprietor?:No
Enumeration Date:2006-02-09
Last Update Date:2007-10-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0017000396363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
Provider Identifiers
StateIdentifier IDID TypeIssuer
S48391Medicare UPIN
006332R77Medicare PIN