Healthcare Provider Details

I. General information

NPI: 1396821773
Provider Name (Legal Business Name): CHRISTEN CALI VANASSELBERG M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 10/28/2006
Last Update Date: 03/06/2022
Certification Date: 03/06/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4201 N I 10 SERVICE RD W
METAIRIE LA
70006-6713
US

IV. Provider business mailing address

4201 N I 10 SERVICE RD W
METAIRIE LA
70006-6713
US

V. Phone/Fax

Practice location:
  • Phone: 769-233-1546
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2084P0800X
TaxonomyPsychiatry Physician
License Number21142
License Number StateMS
# 2
Primary TaxonomyN
Taxonomy Code106S00000X
TaxonomyBehavior Technician
License Number
License Number StateLA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: