Provider Demographics
NPI:1508811894
Name:HORCHAK, CHRISTINE A (PA-C)
Entity Type:Individual
Prefix:
First Name:CHRISTINE
Middle Name:A
Last Name:HORCHAK
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 1:1500 DELHI ST STE 4300
Mailing Address - Street 2:SUITE 4300
Mailing Address - City:DUBUQUE
Mailing Address - State:IA
Mailing Address - Zip Code:52001-6319
Mailing Address - Country:US
Mailing Address - Phone:563-557-5971
Mailing Address - Fax:563-557-5973
Practice Address - Street 1:1500 DELHI ST STE 4300
Practice Address - Street 2:SUITE 4300
Practice Address - City:DUBUQUE
Practice Address - State:IA
Practice Address - Zip Code:52001-6319
Practice Address - Country:US
Practice Address - Phone:563-557-5971
Practice Address - Fax:563-557-5973
Is Sole Proprietor?:No
Enumeration Date:2006-05-24
Last Update Date:2013-02-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ1469363AM0700X
IA002287363AM0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZ832601Medicaid
Q05768Medicare UPIN