Provider Demographics
NPI:1790089506
Name:ANDRADE, CHRISTINA JOAN (RN, CNS)
Entity Type:Individual
Prefix:
First Name:CHRISTINA
Middle Name:JOAN
Last Name:ANDRADE
Suffix:
Gender:F
Credentials:RN, CNS
Other - Prefix:
Other - First Name:CHRISTINA
Other - Middle Name:JOAN
Other - Last Name:RIVERA
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:RN, CNS
Mailing Address - Street 1:401 BICENTENNIAL WAY
Mailing Address - Street 2:
Mailing Address - City:SANTA ROSA
Mailing Address - State:CA
Mailing Address - Zip Code:95403-2149
Mailing Address - Country:US
Mailing Address - Phone:707-393-3129
Mailing Address - Fax:707-393-4863
Practice Address - Street 1:401 BICENTENNIAL WAY
Practice Address - Street 2:
Practice Address - City:SANTA ROSA
Practice Address - State:CA
Practice Address - Zip Code:95403-2149
Practice Address - Country:US
Practice Address - Phone:707-393-3129
Practice Address - Fax:707-393-4863
Is Sole Proprietor?:Yes
Enumeration Date:2011-01-07
Last Update Date:2011-01-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA682435364S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes364S00000XPhysician Assistants & Advanced Practice Nursing ProvidersClinical Nurse Specialist