Provider Demographics
NPI:1912390592
Name:MOHR, CHRISTA LYNN (WMNP)
Entity Type:Individual
Prefix:
First Name:CHRISTA
Middle Name:LYNN
Last Name:MOHR
Suffix:
Gender:F
Credentials:WMNP
Other - Prefix:
Other - First Name:CHRISTA
Other - Middle Name:LYNN
Other - Last Name:STULTS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:100 MICHIGAN ST NE # MC845
Mailing Address - Street 2:
Mailing Address - City:GRAND RAPIDS
Mailing Address - State:MI
Mailing Address - Zip Code:49503-2560
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:722 LOCUST ST
Practice Address - Street 2:
Practice Address - City:BIG RAPIDS
Practice Address - State:MI
Practice Address - Zip Code:49307-2040
Practice Address - Country:US
Practice Address - Phone:231-592-4200
Practice Address - Fax:231-527-6859
Is Sole Proprietor?:No
Enumeration Date:2015-03-06
Last Update Date:2021-02-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI4704195789363LW0102X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LW0102XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerWomen's Health