Healthcare Provider Details

I. General information

NPI: 1447424882
Provider Name (Legal Business Name): CHRISTINA STAVIG DO
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/16/2008
Last Update Date: 02/12/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5320 HYLAND GREENS DR PARK NICOLLET CLINIC - BLOOMINGTON
BLOOMINGTON MN
55437-3938
US

IV. Provider business mailing address

5320 HYLAND GREENS DR PARK NICOLLET CLINIC - BLOOMINGTON
BLOOMINGTON MN
55437-3938
US

V. Phone/Fax

Practice location:
  • Phone: 952-993-2400
  • Fax: 952-993-2522
Mailing address:
  • Phone: 952-993-2400
  • Fax: 952-993-2522

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number50985
License Number StateMN
# 2
Primary TaxonomyN
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: