Provider Demographics
NPI:1083633846
Name:ZAMBON, CHRISTINE M (PA)
Entity type:Individual
Prefix:
First Name:CHRISTINE
Middle Name:M
Last Name:ZAMBON
Suffix:
Gender:F
Credentials:PA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:600 S 2ND ST STE 200
Mailing Address - Street 2:
Mailing Address - City:BISMARCK
Mailing Address - State:ND
Mailing Address - Zip Code:58504-5729
Mailing Address - Country:US
Mailing Address - Phone:701-516-4637
Mailing Address - Fax:877-651-1381
Practice Address - Street 1:4001 DERBY LN
Practice Address - Street 2:
Practice Address - City:RAPID CITY
Practice Address - State:SD
Practice Address - Zip Code:57701-2138
Practice Address - Country:US
Practice Address - Phone:701-516-4637
Practice Address - Fax:877-651-1381
Is Sole Proprietor?:No
Enumeration Date:2006-07-19
Last Update Date:2023-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KS15-01249363A00000X
SD1097363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA012004OtherTRICARE
VAP00167592OtherRAILROAD MEDICARE
VAP00167592OtherRAILROAD MEDICARE
VA012004OtherTRICARE
P31323Medicare UPIN