Healthcare Provider Details

I. General information

NPI: 1477882454
Provider Name (Legal Business Name): CHRISTINE MEREDITH HARLAN FNP-BC
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/21/2009
Last Update Date: 01/30/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2 MEMORIAL DR SUITE 220
ALTON IL
62002-6723
US

IV. Provider business mailing address

670 MASON RIDGE CENTER DR STE 300
SAINT LOUIS MO
63141-8573
US

V. Phone/Fax

Practice location:
  • Phone: 618-474-1723
  • Fax: 618-462-6988
Mailing address:
  • Phone: 618-474-1723
  • Fax: 618-462-6988

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License Number2003018128
License Number StateMO
# 2
Primary TaxonomyN
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License Number041.381061
License Number StateIL
# 3
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number209-008042
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: