Provider Demographics
NPI:1982641023
Name:FIELDS, CHRISTINE ESTHER (CRNA)
Entity Type:Individual
Prefix:
First Name:CHRISTINE
Middle Name:ESTHER
Last Name:FIELDS
Suffix:
Gender:F
Credentials:CRNA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:744 S WEBSTER AVE
Mailing Address - Street 2:
Mailing Address - City:GREEN BAY
Mailing Address - State:WI
Mailing Address - Zip Code:54301-3505
Mailing Address - Country:US
Mailing Address - Phone:920-445-7226
Mailing Address - Fax:920-445-7229
Practice Address - Street 1:4421 DEER VALLEY DR
Practice Address - Street 2:
Practice Address - City:FLORISSANT
Practice Address - State:MO
Practice Address - Zip Code:63034-1730
Practice Address - Country:US
Practice Address - Phone:314-355-6227
Practice Address - Fax:314-355-6227
Is Sole Proprietor?:No
Enumeration Date:2006-05-31
Last Update Date:2016-04-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO066282367500000X
IL209003637367500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367500000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Anesthetist, Certified Registered
Provider Identifiers
StateIdentifier IDID TypeIssuer
MO818964814Medicare ID - Type Unspecified