Provider Demographics
NPI:1285932509
Name:WOLGAMOOD, CHRISTI N (ACNP-BC)
Entity type:Individual
Prefix:
First Name:CHRISTI
Middle Name:N
Last Name:WOLGAMOOD
Suffix:
Gender:F
Credentials:ACNP-BC
Other - Prefix:
Other - First Name:CHRISTI
Other - Middle Name:N
Other - Last Name:GARDNER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:RN
Mailing Address - Street 1:601 JOHN ST
Mailing Address - Street 2:BOX 42
Mailing Address - City:KALAMAZOO
Mailing Address - State:MI
Mailing Address - Zip Code:49007-5341
Mailing Address - Country:US
Mailing Address - Phone:269-341-7333
Mailing Address - Fax:269-341-7371
Practice Address - Street 1:601 JOHN ST
Practice Address - Street 2:SUITE M460
Practice Address - City:KALAMAZOO
Practice Address - State:MI
Practice Address - Zip Code:49007-5341
Practice Address - Country:US
Practice Address - Phone:269-341-7333
Practice Address - Fax:269-341-7371
Is Sole Proprietor?:No
Enumeration Date:2011-03-10
Last Update Date:2023-11-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI4704248537363LA2100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LA2100XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAcute Care
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI1003822412OtherBCBS - BMH
MI1285932509Medicaid
MI1003822412OtherBCBS - BMH