Healthcare Provider Details

I. General information

NPI: 1447107586
Provider Name (Legal Business Name): CHRISTOPHER JOHN WING
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/16/2026
Last Update Date: 03/16/2026
Certification Date: 03/16/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2715 W 4TH ST
GRAND ISLAND NE
68803-4119
US

IV. Provider business mailing address

2715 W 4TH ST
GRAND ISLAND NE
68803-4119
US

V. Phone/Fax

Practice location:
  • Phone: 308-227-1208
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code372600000X
TaxonomyAdult Companion
License Number
License Number StateNE

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: