Provider Demographics
NPI:1831710458
Name:BLACK, CHRISTINE MAIRE (MSN)
Entity type:Individual
Prefix:MISS
First Name:CHRISTINE
Middle Name:MAIRE
Last Name:BLACK
Suffix:
Gender:F
Credentials:MSN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5 OSPREY LN
Mailing Address - Street 2:
Mailing Address - City:MIDDLETOWN
Mailing Address - State:DE
Mailing Address - Zip Code:19709-9179
Mailing Address - Country:US
Mailing Address - Phone:302-883-9361
Mailing Address - Fax:
Practice Address - Street 1:21141 STERLING AVE UNIT 1
Practice Address - Street 2:
Practice Address - City:GEORGETOWN
Practice Address - State:DE
Practice Address - Zip Code:19947-5571
Practice Address - Country:US
Practice Address - Phone:302-856-6967
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-05-05
Last Update Date:2020-05-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
DELJ-0000379363LP0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPediatrics