Provider Demographics
NPI:1083712376
Name:HEAD, CHRISTINE JO (PA)
Entity Type:Individual
Prefix:
First Name:CHRISTINE
Middle Name:JO
Last Name:HEAD
Suffix:
Gender:F
Credentials:PA
Other - Prefix:
Other - First Name:CHRISTINE
Other - Middle Name:JO
Other - Last Name:COLLINS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PA
Mailing Address - Street 1:PO BOX 2797
Mailing Address - Street 2:
Mailing Address - City:OMAHA
Mailing Address - State:NE
Mailing Address - Zip Code:68103-2797
Mailing Address - Country:US
Mailing Address - Phone:402-354-4230
Mailing Address - Fax:402-354-6171
Practice Address - Street 1:8303 DODGE ST
Practice Address - Street 2:
Practice Address - City:OMAHA
Practice Address - State:NE
Practice Address - Zip Code:68114-4108
Practice Address - Country:US
Practice Address - Phone:402-354-4424
Practice Address - Fax:402-354-4435
Is Sole Proprietor?:No
Enumeration Date:2006-09-20
Last Update Date:2017-05-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NEPA 989363AM0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical
Provider Identifiers
StateIdentifier IDID TypeIssuer
NE47037660412Medicaid
IA1083712376Medicaid
NE47037660412Medicaid