Provider Demographics
NPI:1063694354
Name:ZEISS, CHRISTIANA N (FNP)
Entity type:Individual
Prefix:
First Name:CHRISTIANA
Middle Name:N
Last Name:ZEISS
Suffix:
Gender:F
Credentials:FNP
Other - Prefix:
Other - First Name:CHRISTIANA
Other - Middle Name:Z
Other - Last Name:GALLUP
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:FNP
Mailing Address - Street 1:7130 GLEN FOREST DR
Mailing Address - Street 2:SUITE 101
Mailing Address - City:RICHMOND
Mailing Address - State:VA
Mailing Address - Zip Code:23226-3754
Mailing Address - Country:US
Mailing Address - Phone:804-288-4084
Mailing Address - Fax:804-282-8678
Practice Address - Street 1:13801 ST FRANCIS BLVD STE 100
Practice Address - Street 2:
Practice Address - City:MIDLOTHIAN
Practice Address - State:VA
Practice Address - Zip Code:23114-3206
Practice Address - Country:US
Practice Address - Phone:804-288-4084
Practice Address - Fax:804-545-9548
Is Sole Proprietor?:No
Enumeration Date:2007-11-29
Last Update Date:2018-04-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0024166828363LF0000X, 363LW0102X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LW0102XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerWomen's Health
No363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA1063694354Medicaid
VAVVC292AMedicare PIN