Healthcare Provider Details

I. General information

NPI: 1053315689
Provider Name (Legal Business Name): CRISTA MARIE BENNETT PA-C
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: CRISTA MARIE VOTANO PA-C

II. Dates (important events)

Enumeration Date: 06/10/2005
Last Update Date: 12/10/2020
Certification Date: 12/10/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1100 MILLION DOLLAR HWY
SAINT MARYS PA
15857-2728
US

IV. Provider business mailing address

100 HOSPITAL AVE
DU BOIS PA
15801-1440
US

V. Phone/Fax

Practice location:
  • Phone: 814-781-6758
  • Fax: 814-781-3317
Mailing address:
  • Phone: 814-375-6549
  • Fax: 814-372-2864

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363AM0700X
TaxonomyMedical Physician Assistant
License NumberOA000896
License Number StatePA
# 2
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License NumberMA053375
License Number StatePA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: