Provider Demographics
NPI:1982884011
Name:FONGHEISER, CHRISTINE D (RN)
Entity type:Individual
Prefix:
First Name:CHRISTINE
Middle Name:D
Last Name:FONGHEISER
Suffix:
Gender:F
Credentials:RN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:615 BROOKHILL RD
Mailing Address - Street 2:
Mailing Address - City:WEST CHESTER
Mailing Address - State:PA
Mailing Address - Zip Code:19380-1090
Mailing Address - Country:US
Mailing Address - Phone:610-692-4824
Mailing Address - Fax:
Practice Address - Street 1:900 LAWRENCE DR
Practice Address - Street 2:
Practice Address - City:WEST CHESTER
Practice Address - State:PA
Practice Address - Zip Code:19380-3415
Practice Address - Country:US
Practice Address - Phone:610-696-8090
Practice Address - Fax:610-696-8300
Is Sole Proprietor?:Yes
Enumeration Date:2007-11-06
Last Update Date:2007-11-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PARN225368L163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA101164486 0001Medicaid