Provider Demographics
NPI:1558026187
Name:DEERING, CHRISTINE (PA)
Entity type:Individual
Prefix:
First Name:CHRISTINE
Middle Name:
Last Name:DEERING
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 1:2854 HIGHWAY 55 STE 190
Mailing Address - Street 2:
Mailing Address - City:EAGAN
Mailing Address - State:MN
Mailing Address - Zip Code:55121-1783
Mailing Address - Country:US
Mailing Address - Phone:651-644-4277
Mailing Address - Fax:
Practice Address - Street 1:2854 HIGHWAY 55 STE 190
Practice Address - Street 2:
Practice Address - City:EAGAN
Practice Address - State:MN
Practice Address - Zip Code:55121-1783
Practice Address - Country:US
Practice Address - Phone:651-644-4277
Practice Address - Fax:651-644-4018
Is Sole Proprietor?:No
Enumeration Date:2021-11-08
Last Update Date:2024-07-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN14541363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant