Provider Demographics
NPI:1770346660
Name:MAYDEN, CHRISTINE MARIE (RN)
Entity type:Individual
Prefix:
First Name:CHRISTINE
Middle Name:MARIE
Last Name:MAYDEN
Suffix:
Gender:F
Credentials:RN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:ST CLAIR COUNTY VA CLINIC
Mailing Address - Street 2:1190 FORTUNE BLVD
Mailing Address - City:SHILOH
Mailing Address - State:IL
Mailing Address - Zip Code:62269-7358
Mailing Address - Country:US
Mailing Address - Phone:314-286-6988
Mailing Address - Fax:314-289-7660
Practice Address - Street 1:ST CLAIR COUNTY VA CLINIC
Practice Address - Street 2:1190 FORTUNE BLVD
Practice Address - City:SHILOH
Practice Address - State:IL
Practice Address - Zip Code:62269-7358
Practice Address - Country:US
Practice Address - Phone:314-286-6988
Practice Address - Fax:314-289-7660
Is Sole Proprietor?:No
Enumeration Date:2024-02-02
Last Update Date:2024-02-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO113820163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse