MEDICARE: CHRISTA LYNN MOHR WHNP

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	363LW0102X	Women's Health Nurse Practitioner	4704195789	MI

General Provider Information

NPI Number	:	1912390592
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	CHRISTA LYNN MOHR WHNP

Provider Business Mailing Address
First Line	:	100 MICHIGAN ST NE # MC845
Second Line	:
City	:	GRAND RAPIDS
State	:	MI
Zip	:	49503-2560
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	722 LOCUST ST
Second Line	:
City	:	BIG RAPIDS
State	:	MI
Zip	:	49307-2040
Country	:	US
Telephone Number	:	231-592-4200
Fax Number	:	231-527-6859

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

Provider Enumeration Date	:	03/06/2015
Last Update Date	:	04/10/2026

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