Provider Demographics
NPI:1558481044
Name:DESANTIS, CHRISTINE B (APRN)
Entity Type:Individual
Prefix:
First Name:CHRISTINE
Middle Name:B
Last Name:DESANTIS
Suffix:
Gender:F
Credentials:APRN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:88 HANNAH PL
Mailing Address - Street 2:
Mailing Address - City:BAYVILLE
Mailing Address - State:NJ
Mailing Address - Zip Code:08721-2065
Mailing Address - Country:US
Mailing Address - Phone:732-606-0031
Mailing Address - Fax:
Practice Address - Street 1:1427 WYCKOFF RD
Practice Address - Street 2:HORIZON BCBS-HEALTHCENTER
Practice Address - City:WALL TOWNSHIP
Practice Address - State:NJ
Practice Address - Zip Code:07727-3918
Practice Address - Country:US
Practice Address - Phone:732-256-5044
Practice Address - Fax:732-256-5045
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-30
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ26NJ00061400363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily