Healthcare Provider Details

I. General information

NPI: 1750364840
Provider Name (Legal Business Name): CHRISTA R WARTHLING RPAC
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/22/2005
Last Update Date: 04/30/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

415 TREMONT ST
N TONAWANDA NY
14120-6135
US

IV. Provider business mailing address

908 NIAGARA FALLS BLVD STE 208
N TONAWANDA NY
14120-2019
US

V. Phone/Fax

Practice location:
  • Phone: 716-690-2001
  • Fax: 716-692-4342
Mailing address:
  • Phone: 716-692-2160
  • Fax: 716-692-4342

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License Number010668
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: