Provider Demographics
NPI:1144942863
Name:DUBOIS, CHRISTOPHER (FNP)
Entity type:Individual
Prefix:
First Name:CHRISTOPHER
Middle Name:
Last Name:DUBOIS
Suffix:
Gender:M
Credentials:FNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2500 N MAYFAIR RD STE 500
Mailing Address - Street 2:
Mailing Address - City:WAUWATOSA
Mailing Address - State:WI
Mailing Address - Zip Code:53226-1415
Mailing Address - Country:US
Mailing Address - Phone:414-257-2525
Mailing Address - Fax:
Practice Address - Street 1:2500 N MAYFAIR RD STE 500
Practice Address - Street 2:
Practice Address - City:WAUWATOSA
Practice Address - State:WI
Practice Address - Zip Code:53226-1415
Practice Address - Country:US
Practice Address - Phone:414-257-1772
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-09-19
Last Update Date:2022-12-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI235038163W00000X
WI13366-33363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
No163W00000XNursing Service ProvidersRegistered Nurse