Provider Demographics
NPI:1922070044
Name:EDELMAN, CHRISTINA BOOTH (CNM, WHNP)
Entity Type:Individual
Prefix:MS
First Name:CHRISTINA
Middle Name:BOOTH
Last Name:EDELMAN
Suffix:
Gender:F
Credentials:CNM, WHNP
Other - Prefix:MS
Other - First Name:CHRISTINA
Other - Middle Name:GRETCHEN
Other - Last Name:BOOTH
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:NP
Mailing Address - Street 1:955 HARBOR VIEW DR
Mailing Address - Street 2:
Mailing Address - City:SAN DIEGO
Mailing Address - State:CA
Mailing Address - Zip Code:92106-2437
Mailing Address - Country:US
Mailing Address - Phone:619-518-0756
Mailing Address - Fax:619-524-6191
Practice Address - Street 1:34800 BOB WILSON DR NAVAL MEDICAL CENTER SAN DIEGO
Practice Address - Street 2:
Practice Address - City:SAN DIEGO
Practice Address - State:CA
Practice Address - Zip Code:92134-0001
Practice Address - Country:US
Practice Address - Phone:619-532-7082
Practice Address - Fax:619-532-6587
Is Sole Proprietor?:No
Enumeration Date:2006-02-02
Last Update Date:2021-04-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CANP 15499363LW0102X
NJ26NJ0061300363LW0102X
NJ25ME00060800367A00000X
CA1996367A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367A00000XPhysician Assistants & Advanced Practice Nursing ProvidersAdvanced Practice Midwife
No363LW0102XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerWomen's Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA645813OtherRN CA
CARN 645813OtherRN LICENSE
NJ25ME00060801OtherCNM W/PRESCRIPTIVE AUTHORITY
CANP 15499OtherNP LICENSE
CA1996OtherCNM LICENSE
NJ26NJ0061300OtherADVANCED PRACTICE NURSE
NJ26NR18421700OtherRN NJ
CA15499OtherNP WITH FURNISHING
NJ25ME00060800OtherCNM