Provider Demographics
NPI:1871912634
Name:BIRCH, CHRISTINE E (PA-C)
Entity type:Individual
Prefix:
First Name:CHRISTINE
Middle Name:E
Last Name:BIRCH
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
Other - First Name:CHRISTINE
Other - Middle Name:E
Other - Last Name:KOLLAR
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:1032 S BRIDGEWAY PL STE 110
Mailing Address - Street 2:
Mailing Address - City:EAGLE
Mailing Address - State:ID
Mailing Address - Zip Code:83616-6099
Mailing Address - Country:US
Mailing Address - Phone:208-246-0123
Mailing Address - Fax:208-246-0125
Practice Address - Street 1:1032 S BRIDGEWAY PL STE 110
Practice Address - Street 2:
Practice Address - City:EAGLE
Practice Address - State:ID
Practice Address - Zip Code:83616
Practice Address - Country:US
Practice Address - Phone:208-246-0123
Practice Address - Fax:208-246-0125
Is Sole Proprietor?:No
Enumeration Date:2014-04-09
Last Update Date:2019-05-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IDPA-1140363A00000X, 2084P0800X
CA51539363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry
No363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant