Basic Information
| Provider Information | |||||||||
| NPI: | 1710306725 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | ADIQUE | ||||||||
| FirstName: | CHRISTINE | ||||||||
| MiddleName: | T | ||||||||
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| Credential: | APNP | ||||||||
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| Mailing Information | |||||||||
| Address1: | 3400 MARKET LN | ||||||||
| Address2: | |||||||||
| City: | KENOSHA | ||||||||
| State: | WI | ||||||||
| PostalCode: | 531443430 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2625514600 | ||||||||
| FaxNumber: | 2625514630 | ||||||||
| Practice Location | |||||||||
| Address1: | 3400 MARKET LN | ||||||||
| Address2: | |||||||||
| City: | KENOSHA | ||||||||
| State: | WI | ||||||||
| PostalCode: | 531443430 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2625514600 | ||||||||
| FaxNumber: | 2625514630 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 04/08/2014 | ||||||||
| LastUpdateDate: | 03/30/2020 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | Y | ||||||||
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| NPICertificationDate: | 03/30/2020 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 363LP2300X | 209011448 | IL | N | Physician Assistants & Advanced Practice Nursing Providers | Nurse Practitioner | Primary Care | 363L00000X | 8393-33 | WI | Y | Physician Assistants & Advanced Practice Nursing Providers | Nurse Practitioner |
No ID Information.