Provider Demographics
NPI:1518363381
Name:BAMBURG, CHRISTA M (CNM)
Entity Type:Individual
Prefix:
First Name:CHRISTA
Middle Name:M
Last Name:BAMBURG
Suffix:
Gender:F
Credentials:CNM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:20 NORTH ST
Mailing Address - Street 2:
Mailing Address - City:HANOVER
Mailing Address - State:PA
Mailing Address - Zip Code:17331-2275
Mailing Address - Country:US
Mailing Address - Phone:717-637-7755
Mailing Address - Fax:717-637-7142
Practice Address - Street 1:20 NORTH ST
Practice Address - Street 2:
Practice Address - City:HANOVER
Practice Address - State:PA
Practice Address - Zip Code:17331-2275
Practice Address - Country:US
Practice Address - Phone:717-637-7755
Practice Address - Fax:717-637-7142
Is Sole Proprietor?:No
Enumeration Date:2014-11-06
Last Update Date:2021-07-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PARN530684L163W00000X
PAMW010354176B00000X, 207V00000X, 367A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367A00000XPhysician Assistants & Advanced Practice Nursing ProvidersAdvanced Practice Midwife
No163W00000XNursing Service ProvidersRegistered Nurse
No176B00000XOther Service ProvidersMidwife
No207V00000XAllopathic & Osteopathic PhysiciansObstetrics & Gynecology
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA384242FLTMedicare PIN
PA384242EZ3Medicare PIN