Provider Demographics
NPI:1912995325
Name:LOZANO, CHRISTA THERESE (PA C)
Entity type:Individual
Prefix:
First Name:CHRISTA
Middle Name:THERESE
Last Name:LOZANO
Suffix:
Gender:F
Credentials:PA C
Other - Prefix:
Other - First Name:CHRISTA
Other - Middle Name:THERESE
Other - Last Name:RALPH
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:PO BOX 1475
Mailing Address - Street 2:
Mailing Address - City:DES MOINES
Mailing Address - State:IA
Mailing Address - Zip Code:50305-1475
Mailing Address - Country:US
Mailing Address - Phone:515-643-4973
Mailing Address - Fax:
Practice Address - Street 1:800 E 1ST ST
Practice Address - Street 2:SUITE 1700
Practice Address - City:ANKENY
Practice Address - State:IA
Practice Address - Zip Code:50021-2077
Practice Address - Country:US
Practice Address - Phone:515-643-8106
Practice Address - Fax:515-643-8187
Is Sole Proprietor?:No
Enumeration Date:2005-10-10
Last Update Date:2007-08-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IA001506363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
IA29975OtherWELLMARK BLUE SHIELD
IA29975OtherWELLMARK BLUE SHIELD
IAI19189Medicare PIN