Provider Demographics
NPI:1962949396
Name:RODESILER, CHRISTINE MICHELLE (FNP)
Entity type:Individual
Prefix:
First Name:CHRISTINE
Middle Name:MICHELLE
Last Name:RODESILER
Suffix:
Gender:F
Credentials:FNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:152 CEDAR LAKE RD
Mailing Address - Street 2:
Mailing Address - City:BLAIRSTOWN
Mailing Address - State:NJ
Mailing Address - Zip Code:07825-9635
Mailing Address - Country:US
Mailing Address - Phone:314-348-3170
Mailing Address - Fax:
Practice Address - Street 1:152 CEDAR LAKE RD
Practice Address - Street 2:
Practice Address - City:BLAIRSTOWN
Practice Address - State:NJ
Practice Address - Zip Code:07825-9635
Practice Address - Country:US
Practice Address - Phone:314-348-3170
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-01-24
Last Update Date:2022-06-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO2016044202363LF0000X
NJ26NJ00758700363LP2300X, 363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
No363LP2300XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPrimary Care