Provider Demographics
NPI:1487615688
Name:CHRISTOPHERSEN, REBECCA ANNE (FNPC)
Entity type:Individual
Prefix:
First Name:REBECCA
Middle Name:ANNE
Last Name:CHRISTOPHERSEN
Suffix:
Gender:F
Credentials:FNPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
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Other - Credentials:
Mailing Address - Street 1:58 LUSK STREET
Mailing Address - Street 2:UNITED MEDICAL ASSOCIATES PC
Mailing Address - City:JOHNSON CITY
Mailing Address - State:NY
Mailing Address - Zip Code:13790
Mailing Address - Country:US
Mailing Address - Phone:607-763-6293
Mailing Address - Fax:607-763-6717
Practice Address - Street 1:91 CHENANGO BRIDGE ROAD
Practice Address - Street 2:
Practice Address - City:BINGHAMTON
Practice Address - State:NY
Practice Address - Zip Code:13901
Practice Address - Country:US
Practice Address - Phone:607-648-4151
Practice Address - Fax:607-648-7138
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-03-29
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
NY334800363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY02727984Medicaid
Q64494Medicare UPIN
NYRA9754Medicare ID - Type Unspecified