Basic Information
| Provider Information | |||||||||
| NPI: | 1851684666 | ||||||||
| EntityType: | 1 | ||||||||
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| LastName: | OU | ||||||||
| FirstName: | CHRISTINE | ||||||||
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| Credential: | D.O. | ||||||||
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| Mailing Information | |||||||||
| Address1: | 2006 HEALTH CAMPUS DR | ||||||||
| Address2: | |||||||||
| City: | ROCKINGHAM | ||||||||
| State: | VA | ||||||||
| PostalCode: | 228018679 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5406895800 | ||||||||
| FaxNumber: | 7574317136 | ||||||||
| Practice Location | |||||||||
| Address1: | 505 NE 87TH AVE STE 301 | ||||||||
| Address2: | |||||||||
| City: | VANCOUVER | ||||||||
| State: | WA | ||||||||
| PostalCode: | 986641965 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3605141854 | ||||||||
| FaxNumber: | 3605146063 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 05/26/2011 | ||||||||
| LastUpdateDate: | 10/28/2022 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | 10/28/2022 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 208600000X | 0102205217 | VA | N | Allopathic & Osteopathic Physicians | Surgery | 2086S0129X | 0102205217 | VA | N | Allopathic & Osteopathic Physicians | Surgery | Vascular Surgery | 2086S0129X | OP61344996 | WA | Y | Allopathic & Osteopathic Physicians | Surgery | Vascular Surgery |
ID Information
| ID | Type | State | Issuer | Description | 1851684666 | 05 | VA | MEDICAID |