1700889920 NPI number — ANDREA LIANE CHRISTIANSON CNM

Table of content: ANDREA LIANE CHRISTIANSON CNM (NPI 1700889920)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1700889920 NPI number — ANDREA LIANE CHRISTIANSON CNM

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
CHRISTIANSON
Provider First Name:
ANDREA
Provider Middle Name:
LIANE
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
CNM
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1700889920
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
12/10/2014
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

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

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
411 DURHAM RD
Provider Second Line Business Practice Location Address:
BIRTH AND BEYOND
Provider Business Practice Location Address City Name:
MADISON
Provider Business Practice Location Address State Name:
CT
Provider Business Practice Location Address Postal Code:
06443-2041
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
203-613-8884
Provider Business Practice Location Address Fax Number:
203-613-8886
Provider Enumeration Date:
05/23/2005

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: 367A00000X , with the licence number:  391 , registered in the state of CT ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .
  • Taxonomy code: 367A00000X , with the licence number: CMW00139 , registered in the state of RI ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .

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

  • Identifier: 4094445 . This is a "BLUE CROSS BLUE SHIELD" identifier , issued by the state of ( TN ) . This identifiers is of the category "OTHER".
  • Identifier: 008056418 , issued by the state of ( CT ) . This identifiers is of the category "MEDICAID".




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