MEDICARE: MRS. CHRISTINA L.S. WILLMAN PA-C

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	363AM0700X	Medical Physician Assistant	3580	AZ
2	363A00000X	Physician Assistant	3580	AZ
3	363AS0400X	Surgical Physician Assistant	3580	AZ

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1285702464
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MRS. CHRISTINA L.S. WILLMAN PA-C

Provider Business Mailing Address
First Line	:	18444 N 25TH AVE
Second Line	:	SUITE 310
City	:	PHOENIX
State	:	AZ
Zip	:	85023-1261
Country	:	US
Telephone Number	:	623-537-5600
Fax Number	:	866-939-2673

Provider Business Practice Location Address
First Line	:	18444 N 25TH AVE
Second Line	:	SUITE 210
City	:	PHOENIX
State	:	AZ
Zip	:	85023-1261
Country	:	US
Telephone Number	:	623-537-5600
Fax Number	:	866-939-2673

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	12/04/2006
Last Update Date	:	01/20/2014

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Directions to “ MRS. CHRISTINA L.S. WILLMAN PA-C” Practice Location

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