Provider Demographics
NPI:1700202546
Name:WOLTERS, CHRISTIANE (MD)
Entity Type:Individual
Prefix:DR
First Name:CHRISTIANE
Middle Name:
Last Name:WOLTERS
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:13700 FALLING LEAF LN
Mailing Address - Street 2:
Mailing Address - City:PENN VALLEY
Mailing Address - State:CA
Mailing Address - Zip Code:95946-9350
Mailing Address - Country:US
Mailing Address - Phone:530-271-2239
Mailing Address - Fax:
Practice Address - Street 1:13700 FALLING LEAF LN
Practice Address - Street 2:
Practice Address - City:PENN VALLEY
Practice Address - State:CA
Practice Address - Zip Code:95946-9350
Practice Address - Country:US
Practice Address - Phone:530-271-2239
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2014-03-17
Last Update Date:2014-03-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAC51654208D00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208D00000XAllopathic & Osteopathic PhysiciansGeneral Practice