Healthcare Provider Details

I. General information

NPI: 1205145372
Provider Name (Legal Business Name): CHRISTINE E. WILMSEN MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: CHRISTINE E WILMSEN CRAIG MD

II. Dates (important events)

Enumeration Date: 10/06/2010
Last Update Date: 02/06/2025
Certification Date: 02/06/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

11160 VILLAGE NORTH DR
JENNINGS MO
63136-6159
US

IV. Provider business mailing address

2025 ZUMBEHL RD PMB49
SAINT CHARLES MO
63303-2723
US

V. Phone/Fax

Practice location:
  • Phone: 636-288-4149
  • Fax:
Mailing address:
  • Phone: 636-288-4149
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number110575
License Number StateMO
# 2
Primary TaxonomyN
Taxonomy Code208M00000X
TaxonomyHospitalist Physician
License Number110575
License Number StateMO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: