Provider Demographics
NPI:1184903924
Name:WIEBERDINK, CHRISTINE (CPM, LM)
Entity type:Individual
Prefix:
First Name:CHRISTINE
Middle Name:
Last Name:WIEBERDINK
Suffix:
Gender:F
Credentials:CPM, LM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4654 OAKLEY PIRKLE RD
Mailing Address - Street 2:
Mailing Address - City:MARTINEZ
Mailing Address - State:GA
Mailing Address - Zip Code:30907-8852
Mailing Address - Country:US
Mailing Address - Phone:706-373-0495
Mailing Address - Fax:
Practice Address - Street 1:4654 OAKLEY PIRKLE RD
Practice Address - Street 2:
Practice Address - City:MARTINEZ
Practice Address - State:GA
Practice Address - Zip Code:30907-8852
Practice Address - Country:US
Practice Address - Phone:706-373-0495
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-08-10
Last Update Date:2011-08-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SCLMW-0049176B00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes176B00000XOther Service ProvidersMidwife