Provider Demographics
NPI:1770992828
Name:STCLAIR, CHRISTIAN LARSON (NP)
Entity type:Individual
Prefix:
First Name:CHRISTIAN
Middle Name:LARSON
Last Name:STCLAIR
Suffix:
Gender:F
Credentials:NP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4954 N PALMER RD
Mailing Address - Street 2:4TH FLOOR, ROOM 4515
Mailing Address - City:BETHESDA
Mailing Address - State:MD
Mailing Address - Zip Code:20889-5600
Mailing Address - Country:US
Mailing Address - Phone:301-319-7035
Mailing Address - Fax:
Practice Address - Street 1:4954 N PALMER RD
Practice Address - Street 2:4TH FLOOR, ROOM 4515
Practice Address - City:BETHESDA
Practice Address - State:MD
Practice Address - Zip Code:20889-5600
Practice Address - Country:US
Practice Address - Phone:301-319-7035
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2014-08-02
Last Update Date:2020-10-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDR192531363LF0000X
NYF345237363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
MDR192531OtherMARYLAND NP LICENSE
NYF345237OtherNEW YORK NP LICENSE