Healthcare Provider Details

I. General information

NPI: 1801186853
Provider Name (Legal Business Name): CHRISTINA L NOLTE PAC
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: CHRISTINA L GHERKE

II. Dates (important events)

Enumeration Date: 04/12/2011
Last Update Date: 08/04/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

597 LIBERTY STREET
WEST MILFORD WV
26451
US

IV. Provider business mailing address

597 LIBERTY STREET
WEST MILFORD WV
26451
US

V. Phone/Fax

Practice location:
  • Phone: 304-745-4568
  • Fax: 304-326-3700
Mailing address:
  • Phone: 304-745-4568
  • Fax: 304-326-3700

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License Number01477
License Number StateWV

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: