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General NPI Number Information
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NPI Number | 1093348542
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Entity Type | Individual
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Provider Name | CHRISTOPHER SEAN LANCTIN PA-C
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Gender | Male
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Dates
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Enumeration Date | 02/12/2020
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Last Update Date | 09/21/2021
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Provider Practice Location Address
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Address Line | 3366 OAKDALE AVE N STE 303
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City | ROBBINSDALE
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State | MN
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Zip | 55422-2977
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Country | US
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Telephone | 763-520-7700
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Fax | 833-905-2110
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Provider Business Mailing Address
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Address Line | 2001 KILLEBREW DR STE 308
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City | BLOOMINGTON
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State | MN
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Zip | 55425-1886
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Country | US
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Telephone | 651-999-7022
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Fax | 651-999-6970
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 363A00000X
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Taxonomy Name | Physician Assistant
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License Number | 13420
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License Number State | MN
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Taxonomy #2
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Taxonomy Code | 363AM0700X
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Taxonomy Name | Medical Physician Assistant
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License Number | 13420
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License Number State | MN
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