Healthcare Provider Details

I. General information

NPI: 1609836956
Provider Name (Legal Business Name): CHRISTINA DZUBINSKI PAC
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/23/2006
Last Update Date: 02/24/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

W180N8000 TOWN HALL RD TOWN HALL HEALTH CENTER
MENOMONEE FALLS WI
53051-4002
US

IV. Provider business mailing address

W180N8000 TOWN HALL RD TOWN HALL HEALTH CENTER
MENOMONEE FALLS WI
53051-4002
US

V. Phone/Fax

Practice location:
  • Phone: 262-255-2500
  • Fax: 262-255-2434
Mailing address:
  • Phone: 262-255-2500
  • Fax: 262-255-2434

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License Number567
License Number StateWI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: