Provider Demographics
NPI:1669838751
Name:MARQUARDT, CHRISTINE R (PMHNP)
Entity type:Individual
Prefix:
First Name:CHRISTINE
Middle Name:R
Last Name:MARQUARDT
Suffix:
Gender:
Credentials:PMHNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3861 TRITON LN
Mailing Address - Street 2:
Mailing Address - City:FREDERICK
Mailing Address - State:MD
Mailing Address - Zip Code:21704-7007
Mailing Address - Country:US
Mailing Address - Phone:240-388-7420
Mailing Address - Fax:
Practice Address - Street 1:420 E PATRICK ST STE 100
Practice Address - Street 2:
Practice Address - City:FREDERICK
Practice Address - State:MD
Practice Address - Zip Code:21701-6103
Practice Address - Country:US
Practice Address - Phone:301-898-2627
Practice Address - Fax:301-898-2640
Is Sole Proprietor?:Yes
Enumeration Date:2016-01-06
Last Update Date:2025-03-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDR130851363LP0808X
MD905830101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health
No101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)
Provider Identifiers
StateIdentifier IDID TypeIssuer
MD091900400Medicaid