Provider Demographics
NPI:1821068669
Name:PERKOWSKA, CHRISTINE J (PA)
Entity Type:Individual
Prefix:
First Name:CHRISTINE
Middle Name:J
Last Name:PERKOWSKA
Suffix:
Gender:F
Credentials:PA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1331 MAESTAS RD
Mailing Address - Street 2:
Mailing Address - City:TAOS
Mailing Address - State:NM
Mailing Address - Zip Code:87571-6268
Mailing Address - Country:US
Mailing Address - Phone:575-776-7806
Mailing Address - Fax:575-224-3348
Practice Address - Street 1:TAOS WHOLE HEALTH INTEGRATIVE CARE
Practice Address - Street 2:1331 MAESTAS RD
Practice Address - City:TAOS
Practice Address - State:NM
Practice Address - Zip Code:87571-6268
Practice Address - Country:US
Practice Address - Phone:575-776-7806
Practice Address - Fax:575-224-3348
Is Sole Proprietor?:Yes
Enumeration Date:2006-01-24
Last Update Date:2023-07-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NM90PA17363A00000X
367A00000X
NM90-PA17363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
No367A00000XPhysician Assistants & Advanced Practice Nursing ProvidersAdvanced Practice Midwife
Provider Identifiers
StateIdentifier IDID TypeIssuer
NM00094714Medicaid