Provider Demographics
NPI:1386795334
Name:PESESKY, CHRISTINE M (NP)
Entity type:Individual
Prefix:
First Name:CHRISTINE
Middle Name:M
Last Name:PESESKY
Suffix:
Gender:F
Credentials:NP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1 GUTHRIE SQ
Mailing Address - Street 2:
Mailing Address - City:SAYRE
Mailing Address - State:PA
Mailing Address - Zip Code:18840-1625
Mailing Address - Country:US
Mailing Address - Phone:570-888-5858
Mailing Address - Fax:
Practice Address - Street 1:317 W LOCKHART ST
Practice Address - Street 2:
Practice Address - City:SAYRE
Practice Address - State:PA
Practice Address - Zip Code:18840-1618
Practice Address - Country:US
Practice Address - Phone:570-887-2832
Practice Address - Fax:570-887-3035
Is Sole Proprietor?:No
Enumeration Date:2007-01-16
Last Update Date:2015-09-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PASP013286363L00000X
NYF333069363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY02122205Medicaid
NY02122205Medicaid
P27257Medicare UPIN