Provider Demographics
NPI:1164782215
Name:SUJKA, CHRISTINE A
Entity Type:Individual
Prefix:
First Name:CHRISTINE
Middle Name:A
Last Name:SUJKA
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 610
Mailing Address - Street 2:
Mailing Address - City:PINE BLUFFS
Mailing Address - State:WY
Mailing Address - Zip Code:82082-0610
Mailing Address - Country:US
Mailing Address - Phone:307-245-3444
Mailing Address - Fax:307-245-2334
Practice Address - Street 1:805 PINE ST
Practice Address - Street 2:
Practice Address - City:PINE BLUFFS
Practice Address - State:WY
Practice Address - Zip Code:82082
Practice Address - Country:US
Practice Address - Phone:307-245-3444
Practice Address - Fax:307-245-2334
Is Sole Proprietor?:No
Enumeration Date:2012-05-23
Last Update Date:2012-05-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes172V00000XOther Service ProvidersCommunity Health Worker