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General NPI Number Information
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NPI Number | 1770346660
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Entity Type | Individual
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Provider Name | CHRISTINE MARIE MAYDEN RN
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Gender | Female
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Dates
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Enumeration Date | 02/02/2024
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Last Update Date | 02/02/2024
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Provider Practice Location Address
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Address Line | ST CLAIR COUNTY VA CLINIC 1190 FORTUNE BLVD
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City | SHILOH
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State | IL
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Zip | 62269-7358
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Country | US
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Telephone | 314-286-6988
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Fax | 314-289-7660
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Provider Business Mailing Address
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Address Line | ST CLAIR COUNTY VA CLINIC 1190 FORTUNE BLVD
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City | SHILOH
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State | IL
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Zip | 62269-7358
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Country | US
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Telephone | 314-286-6988
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Fax | 314-289-7660
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 163W00000X
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Taxonomy Name | Registered Nurse
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License Number | 113820
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License Number State | MO
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