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General NPI Number Information
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NPI Number | 1487906814
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Entity Type | Individual
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Provider Name | CHRISTINA S SCANLAN PA-C
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Gender | Female
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Dates
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Enumeration Date | 10/09/2012
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Last Update Date | 12/30/2024
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Provider Practice Location Address
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Address Line | 118 9TH AVE N
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City | TWIN FALLS
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State | ID
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Zip | 83301-6352
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Country | US
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Telephone | 208-537-7800
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Fax |
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Provider Business Mailing Address
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Address Line | 1834 W 34TH ST
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City | ERIE
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State | PA
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Zip | 16508-2110
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Country | US
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Telephone | 801-419-2079
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Fax |
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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 | MA064678
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License Number State | PA
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Taxonomy #2
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Taxonomy Code | 363A00000X
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Taxonomy Name | Physician Assistant
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License Number | PA-1009
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License Number State | ID
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