Provider Demographics
NPI:1083650790
Name:CHRISTIE, CHARLES D (PA)
Entity Type:Individual
Prefix:
First Name:CHARLES
Middle Name:D
Last Name:CHRISTIE
Suffix:
Gender:M
Credentials:PA
Other - Prefix:
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Mailing Address - Street 1:516 W 14TH AVE
Mailing Address - Street 2:STE 100
Mailing Address - City:HOLDREGE
Mailing Address - State:NE
Mailing Address - Zip Code:68949-1216
Mailing Address - Country:US
Mailing Address - Phone:308-995-4431
Mailing Address - Fax:308-995-3247
Practice Address - Street 1:516 W 14TH AVE
Practice Address - Street 2:STE 100
Practice Address - City:HOLDREGE
Practice Address - State:NE
Practice Address - Zip Code:68949-1216
Practice Address - Country:US
Practice Address - Phone:308-995-4431
Practice Address - Fax:308-995-3247
Is Sole Proprietor?:No
Enumeration Date:2006-06-21
Last Update Date:2014-06-20
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
NE765363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
269955Medicare PIN
S48497Medicare UPIN
NE0423750001Medicare NSC