Provider Demographics
NPI:1063573053
Name:SLOCUM, CHRISTINE NOEL (ANP-BC, PMHNP-BC)
Entity type:Individual
Prefix:
First Name:CHRISTINE
Middle Name:NOEL
Last Name:SLOCUM
Suffix:
Gender:F
Credentials:ANP-BC, PMHNP-BC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:72 N FOSTERTOWN DR
Mailing Address - Street 2:
Mailing Address - City:NEWBURGH
Mailing Address - State:NY
Mailing Address - Zip Code:12550-8712
Mailing Address - Country:US
Mailing Address - Phone:845-561-3726
Mailing Address - Fax:
Practice Address - Street 1:223 MAIN ST
Practice Address - Street 2:
Practice Address - City:BEACON
Practice Address - State:NY
Practice Address - Zip Code:12508-2770
Practice Address - Country:US
Practice Address - Phone:845-838-4900
Practice Address - Fax:845-838-4915
Is Sole Proprietor?:Yes
Enumeration Date:2006-12-13
Last Update Date:2013-07-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ26NJ00124700363LP0808X
NYF401540363LP0808X
NYF306291-1363LA2200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health
No363LA2200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAdult Health