Provider Demographics
NPI:1366172645
Name:STOLLER, CHRISTINA ANN (AGPCNP-BC)
Entity type:Individual
Prefix:
First Name:CHRISTINA
Middle Name:ANN
Last Name:STOLLER
Suffix:
Gender:F
Credentials:AGPCNP-BC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:550 30TH AVE STE 12
Mailing Address - Street 2:
Mailing Address - City:MOLINE
Mailing Address - State:IL
Mailing Address - Zip Code:61265-5975
Mailing Address - Country:US
Mailing Address - Phone:309-277-1461
Mailing Address - Fax:309-736-1152
Practice Address - Street 1:550 30TH AVE STE 12
Practice Address - Street 2:
Practice Address - City:MOLINE
Practice Address - State:IL
Practice Address - Zip Code:61265-5975
Practice Address - Country:US
Practice Address - Phone:309-277-1461
Practice Address - Fax:309-736-1152
Is Sole Proprietor?:No
Enumeration Date:2022-06-10
Last Update Date:2025-02-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL041.399791163W00000X
IL209.025316363LG0600X
IL209025316207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
No163W00000XNursing Service ProvidersRegistered Nurse
No363LG0600XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerGerontology