Provider Demographics
NPI:1952321861
Name:VANLOOY, CHRISTIE A (PA)
Entity Type:Individual
Prefix:
First Name:CHRISTIE
Middle Name:A
Last Name:VANLOOY
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:PO BOX 146
Mailing Address - Street 2:
Mailing Address - City:BEAVER ISLAND
Mailing Address - State:MI
Mailing Address - Zip Code:49782-0146
Mailing Address - Country:US
Mailing Address - Phone:231-448-2275
Mailing Address - Fax:231-448-2348
Practice Address - Street 1:37304 KINGS HWY
Practice Address - Street 2:
Practice Address - City:BEAVER ISLAND
Practice Address - State:MI
Practice Address - Zip Code:49782-5134
Practice Address - Country:US
Practice Address - Phone:231-448-2275
Practice Address - Fax:231-448-2348
Is Sole Proprietor?:No
Enumeration Date:2006-07-20
Last Update Date:2009-05-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA003309363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
GAQ11788Medicare UPIN
GA97WCGSPMedicare ID - Type Unspecified