Provider Demographics
NPI:1700889920
Name:CHRISTIANSON, ANDREA LIANE (CNM)
Entity Type:Individual
Prefix:
First Name:ANDREA
Middle Name:LIANE
Last Name:CHRISTIANSON
Suffix:
Gender:F
Credentials:CNM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:411 DURHAM RD
Mailing Address - Street 2:BIRTH AND BEYOND
Mailing Address - City:MADISON
Mailing Address - State:CT
Mailing Address - Zip Code:06443-2041
Mailing Address - Country:US
Mailing Address - Phone:203-613-8884
Mailing Address - Fax:203-613-8886
Practice Address - Street 1:411 DURHAM RD
Practice Address - Street 2:BIRTH AND BEYOND
Practice Address - City:MADISON
Practice Address - State:CT
Practice Address - Zip Code:06443-2041
Practice Address - Country:US
Practice Address - Phone:203-613-8884
Practice Address - Fax:203-613-8886
Is Sole Proprietor?:No
Enumeration Date:2005-05-23
Last Update Date:2014-12-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT391367A00000X
RICMW00139367A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367A00000XPhysician Assistants & Advanced Practice Nursing ProvidersAdvanced Practice Midwife
Provider Identifiers
StateIdentifier IDID TypeIssuer
TN4094445OtherBLUE CROSS BLUE SHIELD
CT008056418Medicaid
P17162Medicare UPIN
TN4094445OtherBLUE CROSS BLUE SHIELD