Provider Demographics
NPI:1669237384
Name:VANDERWAL, CHRISTINE S (RN, BSN)
Entity type:Individual
Prefix:
First Name:CHRISTINE
Middle Name:S
Last Name:VANDERWAL
Suffix:
Gender:F
Credentials:RN, BSN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2604 400TH ST
Mailing Address - Street 2:
Mailing Address - City:MARNE
Mailing Address - State:IA
Mailing Address - Zip Code:51552-2102
Mailing Address - Country:US
Mailing Address - Phone:712-732-4758
Mailing Address - Fax:
Practice Address - Street 1:2604 400TH ST
Practice Address - Street 2:
Practice Address - City:MARNE
Practice Address - State:IA
Practice Address - Zip Code:51552-2102
Practice Address - Country:US
Practice Address - Phone:712-732-4758
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-02-21
Last Update Date:2024-02-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IA088447163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse