Healthcare Provider Details

I. General information

NPI: 1285750463
Provider Name (Legal Business Name): CHRISTINE JUDITH ANDERSON N.P.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/21/2007
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

295 VARNUM AVE RIVERSIDE PRIMARY CARE IPA
LOWELL MA
01854-2134
US

IV. Provider business mailing address

31 ELMBROOK RD
BEDFORD MA
01730-1846
US

V. Phone/Fax

Practice location:
  • Phone: 978-452-4100
  • Fax: 978-452-4100
Mailing address:
  • Phone: 781-276-7810
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LG0600X
TaxonomyGerontology Nurse Practitioner
License Number213840
License Number StateMA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: