Provider Demographics
NPI:1497771935
Name:DUETSCH, CHRISTINA M (APRN/PMH)
Entity Type:Individual
Prefix:PROF
First Name:CHRISTINA
Middle Name:M
Last Name:DUETSCH
Suffix:
Gender:F
Credentials:APRN/PMH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8936 BLADE GREEN LN
Mailing Address - Street 2:
Mailing Address - City:COLUMBIA
Mailing Address - State:MD
Mailing Address - Zip Code:21045-2438
Mailing Address - Country:US
Mailing Address - Phone:410-825-2281
Mailing Address - Fax:410-825-0757
Practice Address - Street 1:1407 YORK RD
Practice Address - Street 2:SUITE309
Practice Address - City:LUTHERVILLE
Practice Address - State:MD
Practice Address - Zip Code:21093-6097
Practice Address - Country:US
Practice Address - Phone:410-825-2281
Practice Address - Fax:410-825-0757
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-15
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDR043614163WP0809X, 364SP0809X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Not Answered163WP0809XNursing Service ProvidersRegistered NursePsychiatric/Mental Health, Adult
Not Answered364SP0809XPhysician Assistants & Advanced Practice Nursing ProvidersClinical Nurse SpecialistPsychiatric/Mental Health, Adult
Provider Identifiers
StateIdentifier IDID TypeIssuer
MDS22803Medicare UPIN
MD361L/20IIMedicare ID - Type Unspecified