Individual
MR. BLAINE CHRISTOPHER VAN AUSDELN
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
FNP-C, M.S.
Contact information
Practice address
7373 WEST LN, STOCKTON, CA 95210-3377
(209) 476-3569
(209) 476-3675
Mailing address
7373 WEST LN, STOCKTON, CA 95210-3377
(209) 476-3569
(209) 476-3675
Taxonomy
Speciality
Code
Description
License number
State
363LF0000X
Family Nurse Practitioner
Primary
326768/4523
CA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
RN326768
MEDICAL PROVIDER ID
CA
Enumeration date
06/16/2005
Last updated
07/09/2007
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