Provider Demographics
NPI:1427417708
Name:WALKOWIAK, CHRISTINE E (PA)
Entity Type:Individual
Prefix:
First Name:CHRISTINE
Middle Name:E
Last Name:WALKOWIAK
Suffix:
Gender:F
Credentials:PA
Other - Prefix:
Other - First Name:CHRISTINE
Other - Middle Name:E
Other - Last Name:MILLIKEN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PA
Mailing Address - Street 1:3074 N US 31 S
Mailing Address - Street 2:
Mailing Address - City:TRAVERSE CITY
Mailing Address - State:MI
Mailing Address - Zip Code:49684-4533
Mailing Address - Country:US
Mailing Address - Phone:231-929-1234
Mailing Address - Fax:231-935-0984
Practice Address - Street 1:3074 N US 31 S
Practice Address - Street 2:
Practice Address - City:TRAVERSE CITY
Practice Address - State:MI
Practice Address - Zip Code:49684-4533
Practice Address - Country:US
Practice Address - Phone:231-929-1234
Practice Address - Fax:231-935-0984
Is Sole Proprietor?:No
Enumeration Date:2016-02-16
Last Update Date:2022-04-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI5601007686363AM0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical