Provider Demographics
NPI:1780880781
Name:ANDERSON, CHRISTINE MAREN (CNS)
Entity type:Individual
Prefix:MS
First Name:CHRISTINE
Middle Name:MAREN
Last Name:ANDERSON
Suffix:
Gender:F
Credentials:CNS
Other - Prefix:MS
Other - First Name:CHRISTINE
Other - Middle Name:MAREN
Other - Last Name:NORD
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:2550 UNIVERSITY AVE W.
Mailing Address - Street 2:SUITE 229N
Mailing Address - City:ST PAUL
Mailing Address - State:MN
Mailing Address - Zip Code:55114-2290
Mailing Address - Country:US
Mailing Address - Phone:651-645-3115
Mailing Address - Fax:651-645-2752
Practice Address - Street 1:2550 UNIVERSITY AVE W.
Practice Address - Street 2:SUITE 229N
Practice Address - City:ST PAUL
Practice Address - State:MN
Practice Address - Zip Code:55114-2290
Practice Address - Country:US
Practice Address - Phone:651-645-3115
Practice Address - Fax:651-645-2752
Is Sole Proprietor?:No
Enumeration Date:2007-06-26
Last Update Date:2012-01-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MNR 089675 1163WP0807X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WP0807XNursing Service ProvidersRegistered NursePsychiatric/Mental Health, Child & Adolescent