Provider Demographics
NPI:1245867837
Name:CHRISTIANSON, AARON B (PA-C)
Entity type:Individual
Prefix:
First Name:AARON
Middle Name:B
Last Name:CHRISTIANSON
Suffix:
Gender:M
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 1:620 E MENARD ST
Mailing Address - Street 2:
Mailing Address - City:RIVERTON
Mailing Address - State:IL
Mailing Address - Zip Code:62561
Mailing Address - Country:US
Mailing Address - Phone:217-553-4507
Mailing Address - Fax:
Practice Address - Street 1:620 E MENARD ST
Practice Address - Street 2:
Practice Address - City:RIVERTON
Practice Address - State:IL
Practice Address - Zip Code:62561-9770
Practice Address - Country:US
Practice Address - Phone:217-553-4507
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-03-24
Last Update Date:2020-07-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL085.007797363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant