Provider Demographics
NPI:1497779631
Name:CHRISTOFERSON, BARBARA (ARNP)
Entity Type:Individual
Prefix:
First Name:BARBARA
Middle Name:
Last Name:CHRISTOFERSON
Suffix:
Gender:F
Credentials:ARNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3125 COLBY AVE
Mailing Address - Street 2:SUITE J
Mailing Address - City:EVERETT
Mailing Address - State:WA
Mailing Address - Zip Code:98201-4032
Mailing Address - Country:US
Mailing Address - Phone:425-303-8806
Mailing Address - Fax:425-303-8848
Practice Address - Street 1:3125 COLBY AVE
Practice Address - Street 2:SUITE J
Practice Address - City:EVERETT
Practice Address - State:WA
Practice Address - Zip Code:98201-4032
Practice Address - Country:US
Practice Address - Phone:425-303-8806
Practice Address - Fax:425-303-8848
Is Sole Proprietor?:No
Enumeration Date:2006-07-27
Last Update Date:2011-11-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAAP30000137207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA9647942Medicaid