Provider Demographics
NPI:1295114585
Name:INGVOLDSTAD, CHRISTOPHER (APRN, FNP-BC)
Entity type:Individual
Prefix:
First Name:CHRISTOPHER
Middle Name:
Last Name:INGVOLDSTAD
Suffix:
Gender:M
Credentials:APRN, FNP-BC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:883 BLAKELY RD
Mailing Address - Street 2:UVM MEDICAL CENTER, FAMILY MEDICINE - COLCHESTER
Mailing Address - City:COLCHESTER
Mailing Address - State:VT
Mailing Address - Zip Code:05446-4417
Mailing Address - Country:US
Mailing Address - Phone:802-847-2055
Mailing Address - Fax:802-847-1688
Practice Address - Street 1:883 BLAKELY RD
Practice Address - Street 2:UVM MEDICAL CENTER, FAMILY MEDICINE - COLCHESTER
Practice Address - City:COLCHESTER
Practice Address - State:VT
Practice Address - Zip Code:05446-4417
Practice Address - Country:US
Practice Address - Phone:802-847-2055
Practice Address - Fax:802-847-1688
Is Sole Proprietor?:No
Enumeration Date:2015-05-20
Last Update Date:2016-01-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VT101.0110100363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily