Provider Demographics
NPI:1144783390
Name:PETERSON, CHRISTINA JO
Entity type:Individual
Prefix:
First Name:CHRISTINA
Middle Name:JO
Last Name:PETERSON
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:VANDERBILT DEPARTMENT OF UROLOGY
Mailing Address - Street 2:A-1302 MEDICAL CENTER NORTH
Mailing Address - City:NASHVILLE
Mailing Address - State:TN
Mailing Address - Zip Code:37232-2765
Mailing Address - Country:US
Mailing Address - Phone:615-343-5604
Mailing Address - Fax:
Practice Address - Street 1:631 SW HORNE ST STE 210
Practice Address - Street 2:
Practice Address - City:TOPEKA
Practice Address - State:KS
Practice Address - Zip Code:66606-1663
Practice Address - Country:US
Practice Address - Phone:785-270-7660
Practice Address - Fax:785-232-2564
Is Sole Proprietor?:No
Enumeration Date:2019-04-12
Last Update Date:2025-01-29
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
KS04-49627208800000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208800000XAllopathic & Osteopathic PhysiciansUrology