Provider Demographics
NPI:1780636118
Name:ANDERSON, CHRISTINE LEE (ARNP)
Entity Type:Individual
Prefix:
First Name:CHRISTINE
Middle Name:LEE
Last Name:ANDERSON
Suffix:
Gender:F
Credentials:ARNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 5096
Mailing Address - Street 2:
Mailing Address - City:BELLINGHAM
Mailing Address - State:WA
Mailing Address - Zip Code:98227-5096
Mailing Address - Country:US
Mailing Address - Phone:360-734-2700
Mailing Address - Fax:360-734-8362
Practice Address - Street 1:2979 SQUALICUM PKWY
Practice Address - Street 2:SUITE 101
Practice Address - City:BELLINGHAM
Practice Address - State:WA
Practice Address - Zip Code:98225-1811
Practice Address - Country:US
Practice Address - Phone:360-734-2700
Practice Address - Fax:360-734-8362
Is Sole Proprietor?:No
Enumeration Date:2006-05-16
Last Update Date:2011-07-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAAP30006916363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA0280022OtherL&I AND CRIME VICTIMS
WA9651423Medicaid
WA1780636118Medicaid
WAAF02OtherREGENCE BLUE SHIELD
WAAF02OtherREGENCE BLUE SHIELD
WA0280022OtherL&I AND CRIME VICTIMS
WAG8857643Medicare PIN