Provider Demographics
NPI:1528011467
Name:MOREAU, CHRISTI ANN (MPAS, PA-C)
Entity Type:Individual
Prefix:
First Name:CHRISTI
Middle Name:ANN
Last Name:MOREAU
Suffix:
Gender:F
Credentials:MPAS, PA-C
Other - Prefix:
Other - First Name:CHRISTI
Other - Middle Name:ANN
Other - Last Name:CHREENE
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MPAS, PA-C
Mailing Address - Street 1:20 YORK ST
Mailing Address - Street 2:
Mailing Address - City:NEW HAVEN
Mailing Address - State:CT
Mailing Address - Zip Code:06510-3220
Mailing Address - Country:US
Mailing Address - Phone:203-688-2430
Mailing Address - Fax:203-688-4323
Practice Address - Street 1:20 YORK ST
Practice Address - Street 2:
Practice Address - City:NEW HAVEN
Practice Address - State:CT
Practice Address - Zip Code:06510-3220
Practice Address - Country:US
Practice Address - Phone:203-688-2430
Practice Address - Fax:203-688-4323
Is Sole Proprietor?:No
Enumeration Date:2006-05-19
Last Update Date:2022-06-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LAPA.A10291.RX363AS0400X
CT23.003869363AS0400X, 363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AS0400XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantSurgical
No363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
LA1014443Medicaid
LA5F600PF86OtherMEDICARE - PTAN