Healthcare Provider Details

I. General information

NPI: 1770680118
Provider Name (Legal Business Name): CHRISTA ANN ST. GERMAIN DC, MSN, FNP-BC
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/20/2006
Last Update Date: 01/02/2025
Certification Date: 01/02/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

80 ROUTE 343
MILLBROOK NY
12545-6163
US

IV. Provider business mailing address

80 ROUTE 343
MILLBROOK NY
12545-6163
US

V. Phone/Fax

Practice location:
  • Phone: 845-677-3425
  • Fax: 845-677-5296
Mailing address:
  • Phone: 845-677-3425
  • Fax: 845-677-5296

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number347069
License Number StateNY
# 2
Primary TaxonomyN
Taxonomy Code111N00000X
TaxonomyChiropractor
License NumberNYXOO9434
License Number StateNY
# 3
Primary TaxonomyN
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number29116
License Number StateSC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: