Provider Demographics
NPI:1093348542
Name:LANCTIN, CHRISTOPHER SEAN (PA-C)
Entity Type:Individual
Prefix:
First Name:CHRISTOPHER
Middle Name:SEAN
Last Name:LANCTIN
Suffix:
Gender:M
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 1:2001 KILLEBREW DR STE 308
Mailing Address - Street 2:
Mailing Address - City:BLOOMINGTON
Mailing Address - State:MN
Mailing Address - Zip Code:55425-1886
Mailing Address - Country:US
Mailing Address - Phone:651-999-7022
Mailing Address - Fax:651-999-6970
Practice Address - Street 1:3366 OAKDALE AVE N STE 303
Practice Address - Street 2:
Practice Address - City:ROBBINSDALE
Practice Address - State:MN
Practice Address - Zip Code:55422-2977
Practice Address - Country:US
Practice Address - Phone:763-520-7700
Practice Address - Fax:833-905-2110
Is Sole Proprietor?:No
Enumeration Date:2020-02-12
Last Update Date:2021-09-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN13420363A00000X, 363AM0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
No363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical