Provider Demographics
NPI:1972066033
Name:MASTERMAN, CHRISTINE (MSN,IBCLC)
Entity type:Individual
Prefix:
First Name:CHRISTINE
Middle Name:
Last Name:MASTERMAN
Suffix:
Gender:F
Credentials:MSN,IBCLC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1218 S FOREST DR
Mailing Address - Street 2:
Mailing Address - City:MUSKEGON
Mailing Address - State:MI
Mailing Address - Zip Code:49442-4814
Mailing Address - Country:US
Mailing Address - Phone:231-788-4767
Mailing Address - Fax:
Practice Address - Street 1:1218 S FOREST DR
Practice Address - Street 2:
Practice Address - City:MUSKEGON
Practice Address - State:MI
Practice Address - Zip Code:49442-4814
Practice Address - Country:US
Practice Address - Phone:231-788-4767
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-04-07
Last Update Date:2019-04-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MIL-144368163WL0100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes163WL0100XNursing Service ProvidersRegistered NurseLactation ConsultantGroup - Single Specialty