Individual
CHRISTINA ANDERSON
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
MD
Contact information
Practice address
815 MAIN ST STE A, PEORIA, IL 61602-1080
(309) 672-4977
Mailing address
815 MAIN ST STE A, PEORIA, IL 61602-1080
(309) 672-4977
Taxonomy
Speciality
Code
Description
License number
State
390200000X
Student in an Organized Health Care Education/Training Program
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
125.071192
LICENSE
—
Enumeration date
06/20/2017
Last updated
07/21/2022
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