Provider Demographics
NPI:1598936015
Name:HIERSCHE, CHRISTINA MARIE (PA-C)
Entity Type:Individual
Prefix:
First Name:CHRISTINA
Middle Name:MARIE
Last Name:HIERSCHE
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 1:1208 W 15TH ST
Mailing Address - Street 2:
Mailing Address - City:EDMOND
Mailing Address - State:OK
Mailing Address - Zip Code:73013-3001
Mailing Address - Country:US
Mailing Address - Phone:405-340-2100
Mailing Address - Fax:405-340-1184
Practice Address - Street 1:1208 W 15TH ST
Practice Address - Street 2:
Practice Address - City:EDMOND
Practice Address - State:OK
Practice Address - Zip Code:73013-3001
Practice Address - Country:US
Practice Address - Phone:405-340-2100
Practice Address - Fax:405-340-1184
Is Sole Proprietor?:No
Enumeration Date:2008-03-13
Last Update Date:2009-12-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK1513363AM0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical