Provider Demographics
NPI:1558619908
Name:NAULT, CHRISTINE CLAIRE (FNP-BC)
Entity Type:Individual
Prefix:
First Name:CHRISTINE
Middle Name:CLAIRE
Last Name:NAULT
Suffix:
Gender:F
Credentials:FNP-BC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2218 US HIGHWAY 27 N
Mailing Address - Street 2:
Mailing Address - City:TEKONSHA
Mailing Address - State:MI
Mailing Address - Zip Code:49092-9261
Mailing Address - Country:US
Mailing Address - Phone:517-767-4038
Mailing Address - Fax:
Practice Address - Street 1:2218 US HIGHWAY 27 N
Practice Address - Street 2:
Practice Address - City:TEKONSHA
Practice Address - State:MI
Practice Address - Zip Code:49092-9261
Practice Address - Country:US
Practice Address - Phone:517-767-4038
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2012-08-16
Last Update Date:2014-12-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI4704254592363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI0A37699Medicare PIN