Provider Demographics
NPI:1821064411
Name:CHRISTIAN, STEPHANIE L (PA-C)
Entity Type:Individual
Prefix:MS
First Name:STEPHANIE
Middle Name:L
Last Name:CHRISTIAN
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 1:100 N ACADEMY AVE
Mailing Address - Street 2:
Mailing Address - City:DANVILLE
Mailing Address - State:PA
Mailing Address - Zip Code:17822-3034
Mailing Address - Country:US
Mailing Address - Phone:570-271-6144
Mailing Address - Fax:570-271-6578
Practice Address - Street 1:119 NEVADA DR
Practice Address - Street 2:
Practice Address - City:KULPMONT
Practice Address - State:PA
Practice Address - Zip Code:17834-1957
Practice Address - Country:US
Practice Address - Phone:570-373-1250
Practice Address - Fax:570-373-1718
Is Sole Proprietor?:No
Enumeration Date:2006-02-24
Last Update Date:2009-01-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAOA000545L363A00000X
PAMA002977L363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA049865Medicare ID - Type Unspecified
P04841Medicare UPIN