Provider Demographics
NPI:1710375001
Name:BEAN, CHRISTINA J (MSN FNP-C APRN)
Entity Type:Individual
Prefix:
First Name:CHRISTINA
Middle Name:J
Last Name:BEAN
Suffix:
Gender:F
Credentials:MSN FNP-C APRN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2230 EDSEL LN NW STE 1
Mailing Address - Street 2:
Mailing Address - City:CORYDON
Mailing Address - State:IN
Mailing Address - Zip Code:47112-2136
Mailing Address - Country:US
Mailing Address - Phone:812-734-0303
Mailing Address - Fax:
Practice Address - Street 1:2230 EDSEL LN NW STE 1
Practice Address - Street 2:
Practice Address - City:CORYDON
Practice Address - State:IN
Practice Address - Zip Code:47112-2136
Practice Address - Country:US
Practice Address - Phone:812-734-0303
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2015-01-08
Last Update Date:2020-07-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN71005410A363LF0000X, 208VP0014X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208VP0014XAllopathic & Osteopathic PhysiciansPain MedicineInterventional Pain Medicine
No363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN201320110Medicaid
IN201320110Medicaid