Provider Demographics
NPI:1508937822
Name:MEDROS, CHRISTINE R (CNP)
Entity Type:Individual
Prefix:
First Name:CHRISTINE
Middle Name:R
Last Name:MEDROS
Suffix:
Gender:F
Credentials:CNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:47 HIGH ST STE 101
Mailing Address - Street 2:
Mailing Address - City:NORTH ANDOVER
Mailing Address - State:MA
Mailing Address - Zip Code:01845-5201
Mailing Address - Country:US
Mailing Address - Phone:502-244-9859
Mailing Address - Fax:770-573-9513
Practice Address - Street 1:47 HIGH ST STE 101
Practice Address - Street 2:
Practice Address - City:NORTH ANDOVER
Practice Address - State:MA
Practice Address - Zip Code:01845
Practice Address - Country:US
Practice Address - Phone:502-244-9859
Practice Address - Fax:770-573-9513
Is Sole Proprietor?:No
Enumeration Date:2006-11-10
Last Update Date:2018-09-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MARN183121363LA2200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LA2200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAdult Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
MA110013530AMedicaid
MANP240402OtherMEDICARE
MA8302007OtherEVERCARE
MANP2404OtherBLUE SHIELD
MAP05767Medicare UPIN