Provider Demographics
NPI:1285633941
Name:CHRISTIAN, MICHELLE A (PA)
Entity type:Individual
Prefix:MS
First Name:MICHELLE
Middle Name:A
Last Name:CHRISTIAN
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 1:4692 BROWNSBORO RD
Mailing Address - Street 2:PHYSICIANS ELDERCARE
Mailing Address - City:WINSTON SALEM
Mailing Address - State:NC
Mailing Address - Zip Code:27106-3410
Mailing Address - Country:US
Mailing Address - Phone:336-251-1114
Mailing Address - Fax:336-251-1115
Practice Address - Street 1:4692 BROWNSBORO RD
Practice Address - Street 2:PHYSICIANS ELDERCARE
Practice Address - City:WINSTON SALEM
Practice Address - State:NC
Practice Address - Zip Code:27106-3410
Practice Address - Country:US
Practice Address - Phone:336-251-1114
Practice Address - Fax:336-251-1115
Is Sole Proprietor?:No
Enumeration Date:2005-07-15
Last Update Date:2011-02-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC101536363AM0700X
GA003223363AM0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical
Provider Identifiers
StateIdentifier IDID TypeIssuer
SC0291PAMedicaid
GA100000717BMedicaid
NC2767893AMedicare PIN
R93696Medicare UPIN
GA97WCCJWMedicare ID - Type Unspecified