Individual
MRS. CHRISTINE M PEDERSEN
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
MSPT
Contact information
Practice address
6905 E STATE ST, ROCKFORD, IL 61108
(815) 397-4142
(815) 397-4144
Mailing address
PO BOX 6107, ROCKFORD, IL 61125
(815) 397-4142
(815) 397-4144
Taxonomy
Speciality
Code
Description
License number
State
208100000X
Physical Medicine & Rehabilitation Physician
Primary
070012627
IL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
P00426232
MEDICARE RAILROAD
IL
Enumeration date
08/25/2006
Last updated
12/17/2008
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