Provider Demographics
NPI:1538377411
Name:CHRISTESON, MALISSA SUSANNE (LPN)
Entity type:Individual
Prefix:MRS
First Name:MALISSA
Middle Name:SUSANNE
Last Name:CHRISTESON
Suffix:
Gender:F
Credentials:LPN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1127 BRIDGE ST
Mailing Address - Street 2:
Mailing Address - City:LOWELL
Mailing Address - State:MA
Mailing Address - Zip Code:01850-1206
Mailing Address - Country:US
Mailing Address - Phone:978-459-7034
Mailing Address - Fax:
Practice Address - Street 1:1127 BRIDGE ST
Practice Address - Street 2:
Practice Address - City:LOWELL
Practice Address - State:MA
Practice Address - Zip Code:01850-1206
Practice Address - Country:US
Practice Address - Phone:978-459-7034
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-05-21
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA66265164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse
Provider Identifiers
StateIdentifier IDID TypeIssuer
MA0710873OtherMASS HEALTH PROVIDER