Healthcare Provider Details

I. General information

NPI: 1780880781
Provider Name (Legal Business Name): CHRISTINE MAREN ANDERSON C.N.S.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: MS. CHRISTINE MAREN NORD

II. Dates (important events)

Enumeration Date: 06/26/2007
Last Update Date: 01/31/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2550 UNIVERSITY AVE W. SUITE 229N
ST PAUL MN
55114-2290
US

IV. Provider business mailing address

2550 UNIVERSITY AVE W. SUITE 229N
ST PAUL MN
55114-2290
US

V. Phone/Fax

Practice location:
  • Phone: 651-645-3115
  • Fax: 651-645-2752
Mailing address:
  • Phone: 651-645-3115
  • Fax: 651-645-2752

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163WP0807X
TaxonomyChild & Adolescent Psychiatric/Mental Health Registered Nurse
License NumberR 089675 1
License Number StateMN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: