Provider Demographics
NPI:1386972925
Name:GOTTMAN, CHRISTINE R (ANP)
Entity type:Individual
Prefix:
First Name:CHRISTINE
Middle Name:R
Last Name:GOTTMAN
Suffix:
Gender:F
Credentials:ANP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:13655 RIVERPORT DR
Mailing Address - Street 2:
Mailing Address - City:MARYLAND HEIGHTS
Mailing Address - State:MO
Mailing Address - Zip Code:63043-4812
Mailing Address - Country:US
Mailing Address - Phone:314-592-7055
Mailing Address - Fax:
Practice Address - Street 1:13655 RIVERPORT DR
Practice Address - Street 2:
Practice Address - City:MARYLAND HEIGHTS
Practice Address - State:MO
Practice Address - Zip Code:63043-4812
Practice Address - Country:US
Practice Address - Phone:314-592-7055
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2009-11-19
Last Update Date:2019-03-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO143038363LA2200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LA2200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAdult Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
MO124510016Medicare PIN