MEDICARE: CHRISTINA TREPPENDAHL FNP-BC

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	363L00000X	Nurse Practitioner	R858785	MS

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1922273499
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	CHRISTINA TREPPENDAHL FNP-BC

Provider Business Mailing Address
First Line	:	PO BOX 2746
Second Line	:
City	:	MADISON
State	:	MS
Zip	:	39130-2746
Country	:	US
Telephone Number	:	601-366-0855
Fax Number	:

Provider Business Practice Location Address
First Line	:	1000 HIGHLAND COLONY PKWY
Second Line	:	SUITE 7205
City	:	RIDGELAND
State	:	MS
Zip	:	39157-2073
Country	:	US
Telephone Number	:	601-366-0855
Fax Number	:

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

Provider Enumeration Date	:	04/25/2008
Last Update Date	:	06/26/2013

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