Provider Demographics
NPI:1437965407
Name:PORTWOOD, CHRISTINA
Entity type:Individual
Prefix:
First Name:CHRISTINA
Middle Name:
Last Name:PORTWOOD
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:965 S 27TH ST
Mailing Address - Street 2:
Mailing Address - City:LINCOLN
Mailing Address - State:NE
Mailing Address - Zip Code:68510-3140
Mailing Address - Country:US
Mailing Address - Phone:402-477-3505
Mailing Address - Fax:
Practice Address - Street 1:865 WASHINGTON ST
Practice Address - Street 2:
Practice Address - City:STERLING
Practice Address - State:NE
Practice Address - Zip Code:68443-6074
Practice Address - Country:US
Practice Address - Phone:402-806-2011
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-12-05
Last Update Date:2025-03-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NEF10241055363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily