Provider Demographics
NPI:1922434760
Name:KLINE, JUSTINE M (PA)
Entity Type:Individual
Prefix:
First Name:JUSTINE
Middle Name:M
Last Name:KLINE
Suffix:
Gender:F
Credentials:PA
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Mailing Address - Street 1:1300 S FARMVIEW DR APT A38
Mailing Address - Street 2:
Mailing Address - City:DOVER
Mailing Address - State:DE
Mailing Address - Zip Code:19904-7722
Mailing Address - Country:US
Mailing Address - Phone:570-765-1394
Mailing Address - Fax:302-674-4473
Practice Address - Street 1:103 WOLF CREEK BLVD STE 1
Practice Address - Street 2:
Practice Address - City:DOVER
Practice Address - State:DE
Practice Address - Zip Code:19901-4967
Practice Address - Country:US
Practice Address - Phone:302-674-2420
Practice Address - Fax:302-674-4473
Is Sole Proprietor?:No
Enumeration Date:2013-09-25
Last Update Date:2013-09-26
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
DEC50000909363AS0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AS0400XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantSurgical