Healthcare Provider Details

I. General information

NPI: 1477907830
Provider Name (Legal Business Name): CHRISTINA M RESER FNP-BC
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/21/2016
Last Update Date: 07/27/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

16912 E HART AVE
INDEPENDENCE MO
64055-3040
US

IV. Provider business mailing address

10900 NUCKOLS RD STE 110
GLEN ALLEN VA
23060-9246
US

V. Phone/Fax

Practice location:
  • Phone: 816-529-1011
  • Fax:
Mailing address:
  • Phone: 804-396-6412
  • Fax: 804-482-2756

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number2016009883
License Number StateMO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: