Provider Demographics
NPI:1649804006
Name:BEAUDOIN, CHRISTINE OWENS (FNP)
Entity type:Individual
Prefix:
First Name:CHRISTINE
Middle Name:OWENS
Last Name:BEAUDOIN
Suffix:
Gender:F
Credentials:FNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:105 HALTON VILLAGE CIR STE B
Mailing Address - Street 2:
Mailing Address - City:GREENVILLE
Mailing Address - State:SC
Mailing Address - Zip Code:29607-6832
Mailing Address - Country:US
Mailing Address - Phone:864-627-5020
Mailing Address - Fax:864-234-6633
Practice Address - Street 1:105 HALTON VILLAGE CIR STE B
Practice Address - Street 2:
Practice Address - City:GREENVILLE
Practice Address - State:SC
Practice Address - Zip Code:29607-6832
Practice Address - Country:US
Practice Address - Phone:864-627-5020
Practice Address - Fax:864-234-6633
Is Sole Proprietor?:No
Enumeration Date:2020-02-25
Last Update Date:2020-02-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC23268363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily