Provider Demographics
NPI:1699214999
Name:CHRISTIE CLINIC
Entity Type:Organization
Organization Name:CHRISTIE CLINIC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:APN
Authorized Official - Prefix:MS
Authorized Official - First Name:SHEENA EISEN
Authorized Official - Middle Name:H
Authorized Official - Last Name:ADRADOS
Authorized Official - Suffix:
Authorized Official - Credentials:MSN, FNP-BC
Authorized Official - Phone:217-979-7228
Mailing Address - Street 1:611 LURIA LN
Mailing Address - Street 2:
Mailing Address - City:CHAMPAIGN
Mailing Address - State:IL
Mailing Address - Zip Code:61822-1108
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:611 LURIA LN
Practice Address - Street 2:
Practice Address - City:CHAMPAIGN
Practice Address - State:IL
Practice Address - Zip Code:61822-1108
Practice Address - Country:US
Practice Address - Phone:217-979-7228
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-02-20
Last Update Date:2017-02-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL209015481261Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261Q00000XAmbulatory Health Care FacilitiesClinic/Center