Healthcare Provider Details

I. General information

NPI: 1104051150
Provider Name (Legal Business Name): CHRISTAN M BATTLE PA STUDENT
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/20/2009
Last Update Date: 05/14/2025
Certification Date: 05/14/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

15459 ANNAPOLIS RD
BOWIE MD
20715-1847
US

IV. Provider business mailing address

203 TWILIGHT DR
GOLDSBORO NC
27534-8393
US

V. Phone/Fax

Practice location:
  • Phone: 240-544-0676
  • Fax:
Mailing address:
  • Phone: 407-301-6134
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code1710I1003X
TaxonomyIndependent Duty Medical Technicians
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number State
# 3
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License NumberC0009864
License Number StateMD

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: