Provider Demographics
NPI:1801186853
Name:NOLTE, CHRISTINA L (PAC)
Entity Type:Individual
Prefix:
First Name:CHRISTINA
Middle Name:L
Last Name:NOLTE
Suffix:
Gender:F
Credentials:PAC
Other - Prefix:
Other - First Name:CHRISTINA
Other - Middle Name:L
Other - Last Name:GHERKE
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:597 LIBERTY STREET
Mailing Address - Street 2:
Mailing Address - City:WEST MILFORD
Mailing Address - State:WV
Mailing Address - Zip Code:26451
Mailing Address - Country:US
Mailing Address - Phone:304-745-4568
Mailing Address - Fax:304-326-3700
Practice Address - Street 1:597 LIBERTY STREET
Practice Address - Street 2:
Practice Address - City:WEST MILFORD
Practice Address - State:WV
Practice Address - Zip Code:26451
Practice Address - Country:US
Practice Address - Phone:304-745-4568
Practice Address - Fax:304-326-3700
Is Sole Proprietor?:No
Enumeration Date:2011-04-12
Last Update Date:2016-08-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WV01477363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
WV1801186853Medicaid
WV1801186853Medicaid