Provider Demographics
NPI:1760449029
Name:SCHAFER, CHRISTINA JO (PA-C)
Entity Type:Individual
Prefix:
First Name:CHRISTINA
Middle Name:JO
Last Name:SCHAFER
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
Other - First Name:CHRISTINA
Other - Middle Name:JO
Other - Last Name:VIDACAK
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PA
Mailing Address - Street 1:9001 S 101ST EAST AVE
Mailing Address - Street 2:SUITE 270
Mailing Address - City:TULSA
Mailing Address - State:OK
Mailing Address - Zip Code:74133-5708
Mailing Address - Country:US
Mailing Address - Phone:918-392-7000
Mailing Address - Fax:918-392-7013
Practice Address - Street 1:9001 S 101ST EAST AVE
Practice Address - Street 2:SUITE 270
Practice Address - City:TULSA
Practice Address - State:OK
Practice Address - Zip Code:74133-5708
Practice Address - Country:US
Practice Address - Phone:918-392-7000
Practice Address - Fax:918-392-7013
Is Sole Proprietor?:No
Enumeration Date:2006-04-28
Last Update Date:2014-05-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK1183363AM0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical
Provider Identifiers
StateIdentifier IDID TypeIssuer
OK100131410AMedicaid
OK299716YLV0Medicare PIN
OK100131410AMedicaid
OK249401503Medicare ID - Type Unspecified
OKP54240Medicare UPIN
OK100131410AMedicaid