Provider Demographics
NPI:1811099450
Name:ERSCHEN, CHRISTOPHER HAROLD (PA-C)
Entity type:Individual
Prefix:
First Name:CHRISTOPHER
Middle Name:HAROLD
Last Name:ERSCHEN
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 1:815 E MAIN ST
Mailing Address - Street 2:
Mailing Address - City:LANDER
Mailing Address - State:WY
Mailing Address - Zip Code:82520-3491
Mailing Address - Country:US
Mailing Address - Phone:307-332-9720
Mailing Address - Fax:307-332-8206
Practice Address - Street 1:815 E MAIN ST
Practice Address - Street 2:
Practice Address - City:LANDER
Practice Address - State:WY
Practice Address - Zip Code:82520-3491
Practice Address - Country:US
Practice Address - Phone:307-332-9720
Practice Address - Fax:307-332-8206
Is Sole Proprietor?:No
Enumeration Date:2006-09-03
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WY373363AS0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AS0400XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantSurgical
Provider Identifiers
StateIdentifier IDID TypeIssuer
S52762Medicare UPIN