Provider Demographics
NPI:1437589058
Name:OLDENBOURG, CHRISTINE
Entity Type:Individual
Prefix:
First Name:CHRISTINE
Middle Name:
Last Name:OLDENBOURG
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1000 NEW HORIZONS WAY
Mailing Address - Street 2:
Mailing Address - City:VACAVILLE
Mailing Address - State:CA
Mailing Address - Zip Code:95688-9431
Mailing Address - Country:US
Mailing Address - Phone:707-454-5192
Mailing Address - Fax:707-454-5026
Practice Address - Street 1:1000 NEW HORIZONS WAY
Practice Address - Street 2:
Practice Address - City:VACAVILLE
Practice Address - State:CA
Practice Address - Zip Code:95688-9431
Practice Address - Country:US
Practice Address - Phone:707-454-5192
Practice Address - Fax:707-454-5026
Is Sole Proprietor?:No
Enumeration Date:2013-11-18
Last Update Date:2013-11-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA519960163W00000X, 364SF0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes364SF0001XPhysician Assistants & Advanced Practice Nursing ProvidersClinical Nurse SpecialistFamily Health
No163W00000XNursing Service ProvidersRegistered Nurse