Provider Demographics
NPI:1871537795
Name:ANDEREGG, CHRISTINE B (PA-C)
Entity type:Individual
Prefix:MRS
First Name:CHRISTINE
Middle Name:B
Last Name:ANDEREGG
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:130 MARVIN RD SE
Mailing Address - Street 2:SUITE 112
Mailing Address - City:LACEY
Mailing Address - State:WA
Mailing Address - Zip Code:98503-6100
Mailing Address - Country:US
Mailing Address - Phone:360-357-8822
Mailing Address - Fax:360-413-1502
Practice Address - Street 1:130 MARVIN RD SE
Practice Address - Street 2:SUITE 112
Practice Address - City:LACEY
Practice Address - State:WA
Practice Address - Zip Code:98503-6100
Practice Address - Country:US
Practice Address - Phone:360-357-8822
Practice Address - Fax:360-413-1502
Is Sole Proprietor?:No
Enumeration Date:2006-06-15
Last Update Date:2015-03-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAPA10003787363AM0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA8394975Medicaid
WAS97632Medicare UPIN
WA8394975Medicaid