Provider Demographics
NPI:1669889820
Name:ANDERSON, CHRISTOPHER J (APRN FNP-BC)
Entity type:Individual
Prefix:
First Name:CHRISTOPHER
Middle Name:J
Last Name:ANDERSON
Suffix:
Gender:M
Credentials:APRN FNP-BC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:495 GOLD STAR HWY STE 112
Mailing Address - Street 2:
Mailing Address - City:GROTON
Mailing Address - State:CT
Mailing Address - Zip Code:06340-6229
Mailing Address - Country:US
Mailing Address - Phone:860-245-4126
Mailing Address - Fax:877-927-0171
Practice Address - Street 1:495 GOLD STAR HWY STE 112
Practice Address - Street 2:
Practice Address - City:GROTON
Practice Address - State:CT
Practice Address - Zip Code:06340-6229
Practice Address - Country:US
Practice Address - Phone:860-245-4123
Practice Address - Fax:877-927-0171
Is Sole Proprietor?:No
Enumeration Date:2014-07-18
Last Update Date:2024-03-21
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
CT005820363LP2300X, 363LP2300X
RIAPRN01322363LP2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP2300XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPrimary Care