Provider Demographics
NPI:1447333570
Name:PHELPS, CHRISTINE ANN (PA)
Entity type:Individual
Prefix:DR
First Name:CHRISTINE
Middle Name:ANN
Last Name:PHELPS
Suffix:
Gender:F
Credentials:PA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1225 MARSHALL ST
Mailing Address - Street 2:SUITE 18
Mailing Address - City:CRESCENT CITY
Mailing Address - State:CA
Mailing Address - Zip Code:95531-2281
Mailing Address - Country:US
Mailing Address - Phone:707-464-1989
Mailing Address - Fax:
Practice Address - Street 1:3700 KOLBE RD
Practice Address - Street 2:
Practice Address - City:LORAIN
Practice Address - State:OH
Practice Address - Zip Code:44053-1611
Practice Address - Country:US
Practice Address - Phone:440-960-4522
Practice Address - Fax:440-960-4523
Is Sole Proprietor?:No
Enumeration Date:2006-10-23
Last Update Date:2022-11-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPA13857363A00000X
OH363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAS25172Medicare UPIN
CA0PA138570Medicare ID - Type UnspecifiedMEDICARE