Healthcare Provider Details

I. General information

NPI: 1063261899
Provider Name (Legal Business Name): CHRISTINE NICOLE WARD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/14/2024
Last Update Date: 09/27/2026
Certification Date: 09/27/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

125 WOLF RD STE 212
ALBANY NY
12205-1221
US

IV. Provider business mailing address

125 WOLF RD STE 212
ALBANY NY
12205-1221
US

V. Phone/Fax

Practice location:
  • Phone: 518-417-4260
  • Fax:
Mailing address:
  • Phone: 518-417-4260
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code133V00000X
TaxonomyRegistered Dietitian
License Number011148-01
License Number StateNY
# 2
Primary TaxonomyY
Taxonomy Code133V00000X
TaxonomyRegistered Dietitian
License NumberLDN6544
License Number StateMA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: