Provider Demographics
NPI:1184873796
Name:WHITED, CHRISTOPHER ERIC (MPAS)
Entity type:Individual
Prefix:MR
First Name:CHRISTOPHER
Middle Name:ERIC
Last Name:WHITED
Suffix:
Gender:M
Credentials:MPAS
Other - Prefix:
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Mailing Address - Street 1:PO BOX 6001
Mailing Address - Street 2:
Mailing Address - City:FARGO
Mailing Address - State:ND
Mailing Address - Zip Code:58108-6001
Mailing Address - Country:US
Mailing Address - Phone:701-364-6600
Mailing Address - Fax:701-364-6628
Practice Address - Street 1:3902 13TH AVE S
Practice Address - Street 2:
Practice Address - City:FARGO
Practice Address - State:ND
Practice Address - Zip Code:58103-3357
Practice Address - Country:US
Practice Address - Phone:701-364-6600
Practice Address - Fax:701-364-6628
Is Sole Proprietor?:No
Enumeration Date:2008-09-18
Last Update Date:2015-12-26
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
363A00000X
NDPAC0524363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant