Provider Demographics
NPI:1144013822
Name:PROM, CHRISTINA LINH
Entity type:Individual
Prefix:
First Name:CHRISTINA
Middle Name:LINH
Last Name:PROM
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2728 47TH ST E
Mailing Address - Street 2:
Mailing Address - City:INVER GROVE HEIGHTS
Mailing Address - State:MN
Mailing Address - Zip Code:55076-1143
Mailing Address - Country:US
Mailing Address - Phone:651-210-2876
Mailing Address - Fax:
Practice Address - Street 1:1 VETERANS DR # 2F
Practice Address - Street 2:
Practice Address - City:MINNEAPOLIS
Practice Address - State:MN
Practice Address - Zip Code:55417-2309
Practice Address - Country:US
Practice Address - Phone:612-716-7682
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2025-05-27
Last Update Date:2025-05-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MNR-195992-7163WC2100X, 163WX1500X, 163WW0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WW0000XNursing Service ProvidersRegistered NurseWound Care
No163WC2100XNursing Service ProvidersRegistered NurseContinence Care
No163WX1500XNursing Service ProvidersRegistered NurseOstomy Care