Provider Demographics
NPI:1750631669
Name:KING, CHRISTIE
Entity Type:Individual
Prefix:
First Name:CHRISTIE
Middle Name:
Last Name:KING
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:25 DEPOT ST
Mailing Address - Street 2:
Mailing Address - City:KINGFIELD
Mailing Address - State:ME
Mailing Address - Zip Code:04947
Mailing Address - Country:US
Mailing Address - Phone:207-265-4555
Mailing Address - Fax:207-265-5004
Practice Address - Street 1:25 DEPOT ST
Practice Address - Street 2:
Practice Address - City:KINGFIELD
Practice Address - State:ME
Practice Address - Zip Code:04947
Practice Address - Country:US
Practice Address - Phone:207-265-4555
Practice Address - Fax:207-265-5004
Is Sole Proprietor?:No
Enumeration Date:2012-09-18
Last Update Date:2012-09-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MECNP121086363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily