Healthcare Provider Details

I. General information

NPI: 1982241774
Provider Name (Legal Business Name): CHRISTINA A THAYER PA-C
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/29/2019
Last Update Date: 12/03/2024
Certification Date: 12/03/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

25 N THOMPSON LN
IRWIN PA
15642-9305
US

IV. Provider business mailing address

25 N THOMPSON LN STE E
IRWIN PA
15642-9305
US

V. Phone/Fax

Practice location:
  • Phone: 724-382-4941
  • Fax:
Mailing address:
  • Phone: 724-382-4941
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License NumberMA061218
License Number StatePA
# 2
Primary TaxonomyN
Taxonomy Code363AM0700X
TaxonomyMedical Physician Assistant
License NumberMA061218
License Number StatePA
# 3
Primary TaxonomyN
Taxonomy Code364SP0807X
TaxonomyChild & Adolescent Psychiatric/Mental Health Clinical Nurse Specialist
License NumberMA061218
License Number StatePA
# 4
Primary TaxonomyN
Taxonomy Code364SP0808X
TaxonomyPsychiatric/Mental Health Clinical Nurse Specialist
License NumberMA061218
License Number StatePA
# 5
Primary TaxonomyN
Taxonomy Code364SP0809X
TaxonomyAdult Psychiatric/Mental Health Clinical Nurse Specialist
License NumberMA061218
License Number StatePA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: