Individual
REAVA KHRISTENKO
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
NP
Contact information
Practice address
150 S HUNTINGTON AVE, BOSTON, MA 02130-4817
(617) 232-9500
Mailing address
193 SOUTH ST, CHESTNUT HILL, MA 02467-3630
(617) 921-0966
Taxonomy
Speciality
Code
Description
License number
State
207N00000X
Dermatology Physician
RN2306581
MA
207NS0135X
Procedural Dermatology Physician
RN2306581
MA
363L00000X
Nurse Practitioner
Primary
RN2306581
MA
Other
Enumeration date
11/25/2017
Last updated
11/25/2017
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