Provider Demographics
NPI:1982680682
Name:POE, CHRISTINE ROBERTA (CPNP)
Entity Type:Individual
Prefix:
First Name:CHRISTINE
Middle Name:ROBERTA
Last Name:POE
Suffix:
Gender:F
Credentials:CPNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7675 MADISON ST NE
Mailing Address - Street 2:
Mailing Address - City:FRIDLEY
Mailing Address - State:MN
Mailing Address - Zip Code:55432-2753
Mailing Address - Country:US
Mailing Address - Phone:763-785-4500
Mailing Address - Fax:763-755-3314
Practice Address - Street 1:7675 MADISON ST NE
Practice Address - Street 2:
Practice Address - City:FRIDLEY
Practice Address - State:MN
Practice Address - Zip Code:55432-2753
Practice Address - Country:US
Practice Address - Phone:763-785-4500
Practice Address - Fax:763-755-3314
Is Sole Proprietor?:Not Answered
Enumeration Date:2005-12-15
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MNR0735184363LP0222X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0222XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPediatrics, Critical Care