Provider Demographics
NPI:1528008083
Name:CHRISTINE, AMY BETH (PAC)
Entity Type:Individual
Prefix:
First Name:AMY
Middle Name:BETH
Last Name:CHRISTINE
Suffix:
Gender:F
Credentials:PAC
Other - Prefix:MISS
Other - First Name:AMY
Other - Middle Name:BETH
Other - Last Name:HEWITT
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:118 WASHINGTON ST
Mailing Address - Street 2:
Mailing Address - City:HARRISBURG
Mailing Address - State:PA
Mailing Address - Zip Code:17104-1677
Mailing Address - Country:US
Mailing Address - Phone:717-231-8539
Mailing Address - Fax:717-231-8588
Practice Address - Street 1:111 S FRONT ST
Practice Address - Street 2:
Practice Address - City:HARRISBURG
Practice Address - State:PA
Practice Address - Zip Code:17101-2010
Practice Address - Country:US
Practice Address - Phone:717-782-5908
Practice Address - Fax:717-782-5716
Is Sole Proprietor?:No
Enumeration Date:2006-06-06
Last Update Date:2021-01-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAMA0032001363A00000X, 363AM0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical
No363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA50026379OtherCAPITAL BC
PA077176 GXNMedicare PIN
PAP00017401Medicare PIN
PAP89374Medicare UPIN
PA069729RQJMedicare PIN