Provider Demographics
NPI:1902233752
Name:RADIVOJ, CHRISTINE (FNP-BC)
Entity Type:Individual
Prefix:MS
First Name:CHRISTINE
Middle Name:
Last Name:RADIVOJ
Suffix:
Gender:F
Credentials:FNP-BC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:148 MAIN ST
Mailing Address - Street 2:
Mailing Address - City:WINTERSVILLE
Mailing Address - State:OH
Mailing Address - Zip Code:43953-3734
Mailing Address - Country:US
Mailing Address - Phone:740-346-2702
Mailing Address - Fax:740-346-2645
Practice Address - Street 1:148 MAIN ST
Practice Address - Street 2:
Practice Address - City:WINTERSVILLE
Practice Address - State:OH
Practice Address - Zip Code:43953-3734
Practice Address - Country:US
Practice Address - Phone:740-346-2702
Practice Address - Fax:740-346-2645
Is Sole Proprietor?:No
Enumeration Date:2013-10-10
Last Update Date:2024-03-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHAPRN.CNP.15254363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
WV3810027213Medicaid
OH0093948Medicaid
OHH230421Medicare PIN
WV3810027213Medicaid