Provider Demographics
NPI:1508044041
Name:BROOMELL, CHRISTINA NICOLE (PA-C)
Entity Type:Individual
Prefix:MS
First Name:CHRISTINA
Middle Name:NICOLE
Last Name:BROOMELL
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:MS
Other - First Name:CHRISTINA
Other - Middle Name:NICOLE
Other - Last Name:SOLLERER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PA-C
Mailing Address - Street 1:1605 WILSON AVE
Mailing Address - Street 2:
Mailing Address - City:LANCASTER
Mailing Address - State:PA
Mailing Address - Zip Code:17603-4522
Mailing Address - Country:US
Mailing Address - Phone:443-722-3736
Mailing Address - Fax:
Practice Address - Street 1:1605 WILSON AVE
Practice Address - Street 2:
Practice Address - City:LANCASTER
Practice Address - State:PA
Practice Address - Zip Code:17603-4522
Practice Address - Country:US
Practice Address - Phone:443-722-3736
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-02-06
Last Update Date:2022-10-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDC0003676363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
MD1508044041Medicaid