Provider Demographics
NPI:1891989463
Name:WYBO, CHRISTINE COLLINGS (PA-C)
Entity Type:Individual
Prefix:MRS
First Name:CHRISTINE
Middle Name:COLLINGS
Last Name:WYBO
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 1:1002 HOFFMAN AVE
Mailing Address - Street 2:
Mailing Address - City:ROYAL OAK
Mailing Address - State:MI
Mailing Address - Zip Code:48067-3477
Mailing Address - Country:US
Mailing Address - Phone:248-982-2966
Mailing Address - Fax:
Practice Address - Street 1:35200 DEQUINDRE RD
Practice Address - Street 2:SUITE 100
Practice Address - City:STERLING HEIGHTS
Practice Address - State:MI
Practice Address - Zip Code:48310-4837
Practice Address - Country:US
Practice Address - Phone:586-826-8600
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-08-28
Last Update Date:2012-09-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI5601005036363AM0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical