Provider Demographics
NPI:1912685306
Name:ANDERSON, CHRISTOPHER BRUCE (PMHNP-BC)
Entity Type:Individual
Prefix:
First Name:CHRISTOPHER
Middle Name:BRUCE
Last Name:ANDERSON
Suffix:
Gender:M
Credentials:PMHNP-BC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:270 BELLEVUE AVE # 258
Mailing Address - Street 2:
Mailing Address - City:NEWPORT
Mailing Address - State:RI
Mailing Address - Zip Code:02840-3516
Mailing Address - Country:US
Mailing Address - Phone:410-812-1732
Mailing Address - Fax:
Practice Address - Street 1:1075 SMITH ST STE 2
Practice Address - Street 2:
Practice Address - City:PROVIDENCE
Practice Address - State:RI
Practice Address - Zip Code:02908-2700
Practice Address - Country:US
Practice Address - Phone:401-369-9224
Practice Address - Fax:401-369-9275
Is Sole Proprietor?:No
Enumeration Date:2023-07-06
Last Update Date:2023-12-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
RIAPRN03613363LP0808X
RIRN76462163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health
No163W00000XNursing Service ProvidersRegistered Nurse