Provider Demographics
NPI:1629013032
Name:ACREE, CHRISTOPHER SCOTT (PA)
Entity type:Individual
Prefix:
First Name:CHRISTOPHER
Middle Name:SCOTT
Last Name:ACREE
Suffix:
Gender:M
Credentials:PA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:677 ALA MOANA BLVD SPC 950
Mailing Address - Street 2:
Mailing Address - City:HONOLULU
Mailing Address - State:HI
Mailing Address - Zip Code:96813-5408
Mailing Address - Country:US
Mailing Address - Phone:808-535-5555
Mailing Address - Fax:912-435-5674
Practice Address - Street 1:677 ALA MOANA BLVD SPC 950
Practice Address - Street 2:
Practice Address - City:HONOLULU
Practice Address - State:HI
Practice Address - Zip Code:96813-5408
Practice Address - Country:US
Practice Address - Phone:808-535-5555
Practice Address - Fax:808-535-5556
Is Sole Proprietor?:No
Enumeration Date:2006-06-19
Last Update Date:2024-02-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
HI367363A00000X
SC581363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
HI830769190OtherTAX ID
SC570521956OtherEMPLOYEE ID#