Provider Demographics
NPI:1669102638
Name:JOHNSON, CHRISTINE MARIE (PA-C)
Entity type:Individual
Prefix:MS
First Name:CHRISTINE
Middle Name:MARIE
Last Name:JOHNSON
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:MS
Other - First Name:CHRISTINE
Other - Middle Name:MARIE
Other - Last Name:JOHNSON
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:PA-C
Mailing Address - Street 1:29 GRACE LN
Mailing Address - Street 2:
Mailing Address - City:PLEASANT VALLEY
Mailing Address - State:NY
Mailing Address - Zip Code:12569-7141
Mailing Address - Country:US
Mailing Address - Phone:845-464-5277
Mailing Address - Fax:
Practice Address - Street 1:2510 ROUTE 44
Practice Address - Street 2:
Practice Address - City:SALT POINT
Practice Address - State:NY
Practice Address - Zip Code:12578-8040
Practice Address - Country:US
Practice Address - Phone:845-677-8358
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-06-13
Last Update Date:2022-06-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant