Provider Demographics
NPI:1316911795
Name:SERVELLO, CHRISTAN M (PA)
Entity type:Individual
Prefix:
First Name:CHRISTAN
Middle Name:M
Last Name:SERVELLO
Suffix:
Gender:F
Credentials:PA
Other - Prefix:
Other - First Name:CHRISTAN
Other - Middle Name:M
Other - Last Name:PETTENATI
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PA
Mailing Address - Street 1:501 HOWARD AVENUE
Mailing Address - Street 2:SUITE F2 WOMENS HEALTH AND WELLNESS
Mailing Address - City:ALTOONA
Mailing Address - State:PA
Mailing Address - Zip Code:16601-4899
Mailing Address - Country:US
Mailing Address - Phone:814-889-2012
Mailing Address - Fax:814-889-7864
Practice Address - Street 1:501 HOWARD AVENUE
Practice Address - Street 2:SUITE F2 WOMENS HEALTH AND WELLNESS
Practice Address - City:ALTOONA
Practice Address - State:PA
Practice Address - Zip Code:16601-4899
Practice Address - Country:US
Practice Address - Phone:814-889-2012
Practice Address - Fax:814-889-7864
Is Sole Proprietor?:No
Enumeration Date:2006-02-14
Last Update Date:2013-04-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAMA002248L363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant