Provider Demographics
NPI:1336881697
Name:PETERSON, CHRISTINE PATRICIA
Entity Type:Individual
Prefix:
First Name:CHRISTINE
Middle Name:PATRICIA
Last Name:PETERSON
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1300 REMINGTON RD
Mailing Address - Street 2:
Mailing Address - City:SCHAUMBURG
Mailing Address - State:IL
Mailing Address - Zip Code:60173-4835
Mailing Address - Country:US
Mailing Address - Phone:847-496-5513
Mailing Address - Fax:
Practice Address - Street 1:807 W CATINO ST
Practice Address - Street 2:
Practice Address - City:ARLINGTON HEIGHTS
Practice Address - State:IL
Practice Address - Zip Code:60005-2315
Practice Address - Country:US
Practice Address - Phone:847-259-4256
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-04-08
Last Update Date:2022-04-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3747A0650XNursing Service Related ProvidersTechnicianAttendant Care Provider