Provider Demographics
NPI:1689808370
Name:KANAZIK, CHRISTY-LYNN (CNM)
Entity Type:Individual
Prefix:MS
First Name:CHRISTY-LYNN
Middle Name:
Last Name:KANAZIK
Suffix:
Gender:F
Credentials:CNM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:415 GLEN RD
Mailing Address - Street 2:
Mailing Address - City:SPARTA
Mailing Address - State:NJ
Mailing Address - Zip Code:07871-3114
Mailing Address - Country:US
Mailing Address - Phone:862-377-1371
Mailing Address - Fax:
Practice Address - Street 1:415 GLEN RD
Practice Address - Street 2:
Practice Address - City:SPARTA
Practice Address - State:NJ
Practice Address - Zip Code:07871-3114
Practice Address - Country:US
Practice Address - Phone:862-377-1371
Practice Address - Fax:862-377-1371
Is Sole Proprietor?:No
Enumeration Date:2009-05-08
Last Update Date:2022-09-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAMW010190367A00000X
NYF001407367A00000X
NJ25ME00047001367A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367A00000XPhysician Assistants & Advanced Practice Nursing ProvidersAdvanced Practice Midwife