Provider Demographics
NPI:1003285222
Name:BENTZ, CHRISTIE (PA-C)
Entity Type:Individual
Prefix:MRS
First Name:CHRISTIE
Middle Name:
Last Name:BENTZ
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3027 MOUNTAINWOOD CIR
Mailing Address - Street 2:
Mailing Address - City:JUNEAU
Mailing Address - State:AK
Mailing Address - Zip Code:99801-9624
Mailing Address - Country:US
Mailing Address - Phone:802-558-6758
Mailing Address - Fax:
Practice Address - Street 1:3027 MOUNTAINWOOD CIR
Practice Address - Street 2:
Practice Address - City:JUNEAU
Practice Address - State:AK
Practice Address - Zip Code:99801-9624
Practice Address - Country:US
Practice Address - Phone:802-558-6758
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2015-09-17
Last Update Date:2015-09-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AK102586363AS0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AS0400XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantSurgical