Provider Demographics
NPI:1912769589
Name:ERCOLINE, CHRISTINE LORRAINE (PA)
Entity Type:Individual
Prefix:
First Name:CHRISTINE
Middle Name:LORRAINE
Last Name:ERCOLINE
Suffix:
Gender:F
Credentials:PA
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Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:3200 N DOBSON RD STE B-1
Mailing Address - Street 2:
Mailing Address - City:CHANDLER
Mailing Address - State:AZ
Mailing Address - Zip Code:85224-9608
Mailing Address - Country:US
Mailing Address - Phone:602-491-0703
Mailing Address - Fax:
Practice Address - Street 1:3200 N DOBSON RD STE B-1
Practice Address - Street 2:
Practice Address - City:CHANDLER
Practice Address - State:AZ
Practice Address - Zip Code:85224-9608
Practice Address - Country:US
Practice Address - Phone:602-491-0703
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-01-29
Last Update Date:2024-05-14
Deactivation Date:
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Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant