1376949156 NPI number — MRS. CHRISTINA ANNE WEIDMAN RDN

Table of content: MRS. CHRISTINA ANNE WEIDMAN RDN (NPI 1376949156)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1376949156 NPI number — MRS. CHRISTINA ANNE WEIDMAN RDN

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
WEIDMAN
Provider First Name:
CHRISTINA
Provider Middle Name:
ANNE
Provider Name Prefix Text:
MRS.
Provider Name Suffix Text:
Provider Credential Text:
RDN
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
JABLONSKI
Provider Other First Name:
CHRISTINA
Provider Other Middle Name:
ANNE
Provider Other Name Prefix Text:
MISS
Provider Other Name Suffix Text:
Provider Other Credential Text:
RDN
Provider Other Last Name Type Code:
1

NPI Number Information

NPI Number:
1376949156
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
10/14/2020
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
3231 N CLIFTON AVE UNIT 2N
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
CHICAGO
Provider Business Mailing Address State Name:
IL
Provider Business Mailing Address Postal Code:
60657-3318
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
630-306-5883
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
3231 N CLIFTON AVE
Provider Second Line Business Practice Location Address:
UNIT 2N
Provider Business Practice Location Address City Name:
CHICAGO
Provider Business Practice Location Address State Name:
IL
Provider Business Practice Location Address Postal Code:
60657
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
630-306-5883
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
11/06/2014

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 133V00000X , with the licence number:  164.006026 , registered in the state of IL ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)





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