Healthcare Provider Details

I. General information

NPI: 1548816622
Provider Name (Legal Business Name): CHRISTINE BEAUJEAN PA
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/14/2019
Last Update Date: 05/09/2025
Certification Date: 05/09/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5300 FAR HILLS AVE STE 300
DAYTON OH
45429-2381
US

IV. Provider business mailing address

5300 FAR HILLS AVE STE 300
DAYTON OH
45429-2381
US

V. Phone/Fax

Practice location:
  • Phone: 937-433-7536
  • Fax: 937-433-9612
Mailing address:
  • Phone: 937-433-7536
  • Fax: 937-433-9612

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License Number50.006067RX
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: