Provider Demographics
NPI:1538447453
Name:VESNAUGH, CHRISTINE (MSN)
Entity type:Individual
Prefix:
First Name:CHRISTINE
Middle Name:
Last Name:VESNAUGH
Suffix:
Gender:F
Credentials:MSN
Other - Prefix:
Other - First Name:CHRISTINE
Other - Middle Name:
Other - Last Name:BOWER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MSN
Mailing Address - Street 1:8033 E 10 MILE RD
Mailing Address - Street 2:SUITE 101
Mailing Address - City:CENTER LINE
Mailing Address - State:MI
Mailing Address - Zip Code:48015-1427
Mailing Address - Country:US
Mailing Address - Phone:586-977-2900
Mailing Address - Fax:586-977-2992
Practice Address - Street 1:8033 E 10 MILE RD
Practice Address - Street 2:SUITE 101
Practice Address - City:CENTER LINE
Practice Address - State:MI
Practice Address - Zip Code:48015-1427
Practice Address - Country:US
Practice Address - Phone:586-977-2900
Practice Address - Fax:586-977-2992
Is Sole Proprietor?:No
Enumeration Date:2011-07-26
Last Update Date:2013-10-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI4704234874363LA2200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LA2200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAdult Health