MEDICARE: ANDREA LIANE CHRISTIANSON CNM

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	367A00000X	Advanced Practice Midwife	391	CT
2	367A00000X	Advanced Practice Midwife	CMW00139	RI

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	4094445	OTHER	TN	BLUE CROSS BLUE SHIELD
2	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1700889920
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	ANDREA LIANE CHRISTIANSON CNM

Provider Business Mailing Address
First Line	:	411 DURHAM RD
Second Line	:	BIRTH AND BEYOND
City	:	MADISON
State	:	CT
Zip	:	06443-2041
Country	:	US
Telephone Number	:	203-613-8884
Fax Number	:	203-613-8886

Provider Business Practice Location Address
First Line	:	411 DURHAM RD
Second Line	:	BIRTH AND BEYOND
City	:	MADISON
State	:	CT
Zip	:	06443-2041
Country	:	US
Telephone Number	:	203-613-8884
Fax Number	:	203-613-8886

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	05/23/2005
Last Update Date	:	12/10/2014

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