Provider Demographics
NPI:1124584149
Name:NELSON, CHRISTIE LIN (PA-C)
Entity Type:Individual
Prefix:
First Name:CHRISTIE
Middle Name:LIN
Last Name:NELSON
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 1:590 VALLEY HEALTH PLZ
Mailing Address - Street 2:
Mailing Address - City:PARAMUS
Mailing Address - State:NJ
Mailing Address - Zip Code:07652-3605
Mailing Address - Country:US
Mailing Address - Phone:201-527-7370
Mailing Address - Fax:
Practice Address - Street 1:590 VALLEY HEALTH PLZ
Practice Address - Street 2:
Practice Address - City:PARAMUS
Practice Address - State:NJ
Practice Address - Zip Code:07652-3605
Practice Address - Country:US
Practice Address - Phone:201-527-7370
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-02-14
Last Update Date:2023-11-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAPA61413329363AS0400X
CO1124584149363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
No363AS0400XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantSurgical