Basic Information
| Provider Information | |||||||||
| NPI: | 1770712788 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | WARD | ||||||||
| FirstName: | CHRISTINA | ||||||||
| MiddleName: | MARIE | ||||||||
| NamePrefix: | DR. | ||||||||
| NameSuffix: | |||||||||
| Credential: | M.D. | ||||||||
| OtherOrganizationName: | |||||||||
| OtherOrganizationType: | |||||||||
| OtherLastName: | HANSEN | ||||||||
| OtherFirstName: | CHRISTINA | ||||||||
| OtherMiddleName: | MARIE | ||||||||
| OtherNamePrefix: | |||||||||
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| OtherCredential: | |||||||||
| OtherLastNameType: | 1 | ||||||||
| Mailing Information | |||||||||
| Address1: | 3300 OAKDALE AVE N | ||||||||
| Address2: | |||||||||
| City: | ROBBINSDALE | ||||||||
| State: | MN | ||||||||
| PostalCode: | 554222926 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7635815900 | ||||||||
| FaxNumber: | 7635815901 | ||||||||
| Practice Location | |||||||||
| Address1: | 9855 HOSPITAL DR STE 104 | ||||||||
| Address2: | |||||||||
| City: | MAPLE GROVE | ||||||||
| State: | MN | ||||||||
| PostalCode: | 553694648 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7635815900 | ||||||||
| FaxNumber: | 7635815901 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 07/11/2009 | ||||||||
| LastUpdateDate: | 04/25/2018 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | Y | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207R00000X | 6051 | NE | N | Allopathic & Osteopathic Physicians | Internal Medicine | 207R00000X | A145545 | CA | N | Allopathic & Osteopathic Physicians | Internal Medicine | 207R00000X | 63227 | MN | Y | Allopathic & Osteopathic Physicians | Internal Medicine |
No ID Information.