Individual
CHRISTINA MARIE FRESTON
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
DO
Contact information
Practice address
1552 N CRESTMONT DR STE B, MERIDIAN, ID 83642-2193
(208) 985-2260
Mailing address
1552 N CRESTMONT DR STE B, MERIDIAN, ID 83642-2193
(208) 985-2260
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
DO2536
ME
207Q00000X
Family Medicine Physician
Primary
O-1330
ID
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
E400232990
MEDICARE PTAN
ME
Enumeration date
07/03/2012
Last updated
11/09/2021
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