Provider Demographics
NPI:1134333099
Name:CHARBONNEAU, CHRISTINE PETZE (FNP RN)
Entity type:Individual
Prefix:MS
First Name:CHRISTINE
Middle Name:PETZE
Last Name:CHARBONNEAU
Suffix:
Gender:F
Credentials:FNP RN
Other - Prefix:
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Mailing Address - Street 1:4904 FREMONT COURT
Mailing Address - Street 2:
Mailing Address - City:GLEN ALLEN
Mailing Address - State:VA
Mailing Address - Zip Code:23059
Mailing Address - Country:US
Mailing Address - Phone:804-828-7902
Mailing Address - Fax:804-828-6688
Practice Address - Street 1:1300 W BROAD STREET
Practice Address - Street 2:VIRGINIA COMMONWEALTH UNIVERSITY STUDENT HEALTH SERVICE
Practice Address - City:RICHMOND
Practice Address - State:VA
Practice Address - Zip Code:23284
Practice Address - Country:US
Practice Address - Phone:804-828-7902
Practice Address - Fax:804-828-6688
Is Sole Proprietor?:No
Enumeration Date:2007-05-10
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
VA0001153580163W00000X
VA0017001242363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Not Answered163W00000XNursing Service ProvidersRegistered Nurse
Not Answered363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner