Basic Information
| Provider Information | |||||||||
| NPI: | 1487615688 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | CHRISTOPHERSEN | ||||||||
| FirstName: | REBECCA | ||||||||
| MiddleName: | ANNE | ||||||||
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| Credential: | FNPC | ||||||||
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| Mailing Information | |||||||||
| Address1: | 58 LUSK STREET | ||||||||
| Address2: | UNITED MEDICAL ASSOCIATES PC | ||||||||
| City: | JOHNSON CITY | ||||||||
| State: | NY | ||||||||
| PostalCode: | 13790 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6077636293 | ||||||||
| FaxNumber: | 6077636717 | ||||||||
| Practice Location | |||||||||
| Address1: | 91 CHENANGO BRIDGE ROAD | ||||||||
| Address2: | |||||||||
| City: | BINGHAMTON | ||||||||
| State: | NY | ||||||||
| PostalCode: | 13901 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6076484151 | ||||||||
| FaxNumber: | 6076487138 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 03/29/2006 | ||||||||
| LastUpdateDate: | 07/08/2007 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | X | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 363LF0000X | 334800 | NY | Y | Physician Assistants & Advanced Practice Nursing Providers | Nurse Practitioner | Family |
ID Information
| ID | Type | State | Issuer | Description | 02727984 | 05 | NY | MEDICAID |