Provider Demographics
NPI:1194061788
Name:OBERG, CHRISTINE LOUISE (CNP)
Entity type:Individual
Prefix:MRS
First Name:CHRISTINE
Middle Name:LOUISE
Last Name:OBERG
Suffix:
Gender:F
Credentials:CNP
Other - Prefix:
Other - First Name:CHRISTINE
Other - Middle Name:LOUISE
Other - Last Name:CONNORS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:4333 PAN AMERICAN FWY NE STE C
Mailing Address - Street 2:
Mailing Address - City:ALBUQUERQUE
Mailing Address - State:NM
Mailing Address - Zip Code:87107-6833
Mailing Address - Country:US
Mailing Address - Phone:505-600-2511
Mailing Address - Fax:505-300-4977
Practice Address - Street 1:4333 PAN AMERICAN FWY NE STE C
Practice Address - Street 2:
Practice Address - City:ALBUQUERQUE
Practice Address - State:NM
Practice Address - Zip Code:87107-6833
Practice Address - Country:US
Practice Address - Phone:505-600-2511
Practice Address - Fax:505-300-4977
Is Sole Proprietor?:No
Enumeration Date:2012-12-31
Last Update Date:2019-09-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NMCNP 02174363LA2100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LA2100XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAcute Care
Provider Identifiers
StateIdentifier IDID TypeIssuer
NM10131272Medicaid
296751YTE3Medicare PIN