Provider Demographics
NPI:1811764384
Name:CHRISTOPHER, VOSHTY LA'DAZIA (CRNP-PMH)
Entity type:Individual
Prefix:MS
First Name:VOSHTY
Middle Name:LA'DAZIA
Last Name:CHRISTOPHER
Suffix:
Gender:F
Credentials:CRNP-PMH
Other - Prefix:MS
Other - First Name:VASHTY
Other - Middle Name:LA'DAZIA
Other - Last Name:CHRISTOPHER
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:PO BOX 1978
Mailing Address - Street 2:
Mailing Address - City:SALISBURY
Mailing Address - State:MD
Mailing Address - Zip Code:21802-1978
Mailing Address - Country:US
Mailing Address - Phone:410-749-1015
Mailing Address - Fax:410-749-0654
Practice Address - Street 1:10344 OLD OCEAN CITY BLVD STE 2
Practice Address - Street 2:
Practice Address - City:BERLIN
Practice Address - State:MD
Practice Address - Zip Code:21811-1162
Practice Address - Country:US
Practice Address - Phone:410-641-3340
Practice Address - Fax:410-641-3341
Is Sole Proprietor?:No
Enumeration Date:2023-12-05
Last Update Date:2024-07-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDR237271363LP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
MD119591300Medicaid