Provider Demographics
NPI:1346261724
Name:BUCKWALTER, CHRISTINE L
Entity Type:Individual
Prefix:
First Name:CHRISTINE
Middle Name:L
Last Name:BUCKWALTER
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:CHRISTINE
Other - Middle Name:L
Other - Last Name:DEITCH
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:15 BRIARWOOD LN
Mailing Address - Street 2:
Mailing Address - City:NEW WILMINGTON
Mailing Address - State:PA
Mailing Address - Zip Code:16142-1937
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:740 E STATE ST
Practice Address - Street 2:
Practice Address - City:SHARON
Practice Address - State:PA
Practice Address - Zip Code:16146-3328
Practice Address - Country:US
Practice Address - Phone:724-983-3911
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-07-21
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PARN285609L367500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367500000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Anesthetist, Certified Registered
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA025494QH0Medicare ID - Type Unspecified