Provider Demographics
NPI:1730621467
Name:RADTKE, CHRISTIN (FNP-C)
Entity type:Individual
Prefix:
First Name:CHRISTIN
Middle Name:
Last Name:RADTKE
Suffix:
Gender:F
Credentials:FNP-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2945 HAZELWOOD ST STE 100
Mailing Address - Street 2:
Mailing Address - City:MAPLEWOOD
Mailing Address - State:MN
Mailing Address - Zip Code:55109-1241
Mailing Address - Country:US
Mailing Address - Phone:651-232-7800
Mailing Address - Fax:651-232-7940
Practice Address - Street 1:2945 HAZELWOOD ST STE 100
Practice Address - Street 2:
Practice Address - City:MAPLEWOOD
Practice Address - State:MN
Practice Address - Zip Code:55109-1241
Practice Address - Country:US
Practice Address - Phone:651-232-7800
Practice Address - Fax:651-232-7940
Is Sole Proprietor?:No
Enumeration Date:2016-11-11
Last Update Date:2018-03-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MNCNP 4993363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily