Provider Demographics
NPI:1427692573
Name:MAUST, CHRISTINA MARIA
Entity type:Individual
Prefix:MISS
First Name:CHRISTINA
Middle Name:MARIA
Last Name:MAUST
Suffix:
Gender:F
Credentials:
Other - Prefix:MISS
Other - First Name:CHRISTINA
Other - Middle Name:M
Other - Last Name:GROGG
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:RN
Mailing Address - Street 1:99 BELGIAN LN
Mailing Address - Street 2:
Mailing Address - City:MORGANTOWN
Mailing Address - State:WV
Mailing Address - Zip Code:26508-1146
Mailing Address - Country:US
Mailing Address - Phone:304-612-0325
Mailing Address - Fax:
Practice Address - Street 1:1200 J D ANDERSON DR
Practice Address - Street 2:
Practice Address - City:MORGANTOWN
Practice Address - State:WV
Practice Address - Zip Code:26505-3494
Practice Address - Country:US
Practice Address - Phone:304-598-1200
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-11-01
Last Update Date:2020-01-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WV61825163W00000X
WV105397367500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367500000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Anesthetist, Certified Registered
No163W00000XNursing Service ProvidersRegistered Nurse