Individual
CHRISTOPHER ERIC VANDIVER
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
CRNA
Contact information
Practice address
54 HOSPITAL DR, OSAGE BEACH, MO 65065-3050
(573) 302-1661
(573) 302-1719
Mailing address
PO BOX 840, OSAGE BEACH, MO 65065-0840
(573) 302-1661
(573) 302-1719
Taxonomy
Speciality
Code
Description
License number
State
163W00000X
Registered Nurse
RN9359099
FL
367500000X
Certified Registered Nurse Anesthetist
Primary
2013037716
MO
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
1023453289
—
MO
Enumeration date
05/01/2013
Last updated
03/06/2014
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