Provider Demographics
NPI:1679839161
Name:WEGLARZ, CHRISTINE (MSN,ANP-BC,CDE)
Entity Type:Individual
Prefix:
First Name:CHRISTINE
Middle Name:
Last Name:WEGLARZ
Suffix:
Gender:F
Credentials:MSN,ANP-BC,CDE
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:28905 WOODWARD AVE
Mailing Address - Street 2:
Mailing Address - City:BERKLEY
Mailing Address - State:MI
Mailing Address - Zip Code:48072-0923
Mailing Address - Country:US
Mailing Address - Phone:248-551-7508
Mailing Address - Fax:248-551-7580
Practice Address - Street 1:28905 WOODWARD AVE
Practice Address - Street 2:
Practice Address - City:BERKLEY
Practice Address - State:MI
Practice Address - Zip Code:48072-0923
Practice Address - Country:US
Practice Address - Phone:248-551-7508
Practice Address - Fax:248-551-7580
Is Sole Proprietor?:No
Enumeration Date:2012-04-09
Last Update Date:2020-10-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI4704190410363L00000X, 363LA2200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LA2200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAdult Health
No363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner