Provider Demographics
NPI:1508833674
Name:CHRISTLIEB, APRIL M (PA-C)
Entity Type:Individual
Prefix:
First Name:APRIL
Middle Name:M
Last Name:CHRISTLIEB
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
Other - First Name:APRIL
Other - Middle Name:M
Other - Last Name:RICHARD
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:5052 N CLINTON ST
Mailing Address - Street 2:
Mailing Address - City:FORT WAYNE
Mailing Address - State:IN
Mailing Address - Zip Code:46825-5822
Mailing Address - Country:US
Mailing Address - Phone:260-408-2203
Mailing Address - Fax:260-408-8014
Practice Address - Street 1:5050 N CLINTON ST
Practice Address - Street 2:
Practice Address - City:FORT WAYNE
Practice Address - State:IN
Practice Address - Zip Code:46825-5886
Practice Address - Country:US
Practice Address - Phone:260-484-8551
Practice Address - Fax:260-482-5060
Is Sole Proprietor?:No
Enumeration Date:2006-03-07
Last Update Date:2021-05-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN99017902A363A00000X
IN10000851A363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
INP00393345OtherRR MEDICARE
IN5506830003Medicare NSC
IN5506830001Medicare NSC
INP00393345OtherRR MEDICARE
INP00393345Medicare PIN