Provider Demographics
NPI:1558457705
Name:REESOR, CHRISTINE ROSE (FNP)
Entity Type:Individual
Prefix:
First Name:CHRISTINE
Middle Name:ROSE
Last Name:REESOR
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 1:6503 COCKERILLE AVE
Mailing Address - Street 2:
Mailing Address - City:TAKOMA PARK
Mailing Address - State:MD
Mailing Address - Zip Code:20912-4733
Mailing Address - Country:US
Mailing Address - Phone:301-891-2985
Mailing Address - Fax:
Practice Address - Street 1:1618 MONROE ST NW
Practice Address - Street 2:
Practice Address - City:WASHINGTON
Practice Address - State:DC
Practice Address - Zip Code:20010-1804
Practice Address - Country:US
Practice Address - Phone:202-939-2413
Practice Address - Fax:202-232-1970
Is Sole Proprietor?:No
Enumeration Date:2006-10-05
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
DCRN65566363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily