Provider Demographics
NPI:1528114956
Name:SAVAGE, CHRISTINE DIANE (RNC,APN)
Entity type:Individual
Prefix:
First Name:CHRISTINE
Middle Name:DIANE
Last Name:SAVAGE
Suffix:
Gender:F
Credentials:RNC,APN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6030 GARRETT LN
Mailing Address - Street 2:
Mailing Address - City:ROCKFORD
Mailing Address - State:IL
Mailing Address - Zip Code:61107-6637
Mailing Address - Country:US
Mailing Address - Phone:815-226-1172
Mailing Address - Fax:815-226-1595
Practice Address - Street 1:6030 GARRETT LN
Practice Address - Street 2:
Practice Address - City:ROCKFORD
Practice Address - State:IL
Practice Address - Zip Code:61107-6637
Practice Address - Country:US
Practice Address - Phone:815-226-1172
Practice Address - Fax:815-226-1595
Is Sole Proprietor?:No
Enumeration Date:2007-01-26
Last Update Date:2013-11-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL209002341363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
Provider Identifiers
StateIdentifier IDID TypeIssuer
ILQ75855Medicare UPIN