Provider Demographics
NPI:1982636452
Name:STARCK, CHRISTINE E (CNP)
Entity Type:Individual
Prefix:
First Name:CHRISTINE
Middle Name:E
Last Name:STARCK
Suffix:
Gender:F
Credentials:CNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:16000 PEARL RD # 309
Mailing Address - Street 2:METROHEALTH STRONGSVILLE MEDICAL GROUP
Mailing Address - City:CLEVELAND
Mailing Address - State:OH
Mailing Address - Zip Code:44136-6082
Mailing Address - Country:US
Mailing Address - Phone:440-238-2124
Mailing Address - Fax:
Practice Address - Street 1:16000 PEARL RD # 309
Practice Address - Street 2:METROHEALTH STRONGSVILLE MEDICAL GROUP
Practice Address - City:CLEVELAND
Practice Address - State:OH
Practice Address - Zip Code:44136-6082
Practice Address - Country:US
Practice Address - Phone:440-238-2124
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-07-07
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHNP04879363LP0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH2124838Medicaid
OHS78345Medicare UPIN
OHSTNP75571Medicare ID - Type Unspecified