Provider Demographics
NPI:1902094675
Name:LAGROW, CHRISTINE C (PA-C)
Entity Type:Individual
Prefix:
First Name:CHRISTINE
Middle Name:C
Last Name:LAGROW
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:255 S DOBSON RD STE 1
Mailing Address - Street 2:
Mailing Address - City:CHANDLER
Mailing Address - State:AZ
Mailing Address - Zip Code:85224-6231
Mailing Address - Country:US
Mailing Address - Phone:480-722-2595
Mailing Address - Fax:480-722-2599
Practice Address - Street 1:255 S DOBSON RD STE 1
Practice Address - Street 2:
Practice Address - City:CHANDLER
Practice Address - State:AZ
Practice Address - Zip Code:85224-6231
Practice Address - Country:US
Practice Address - Phone:480-722-2595
Practice Address - Fax:480-722-2599
Is Sole Proprietor?:No
Enumeration Date:2007-10-09
Last Update Date:2018-11-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ3723363AM0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical
Provider Identifiers
StateIdentifier IDID TypeIssuer
Z144814Medicare Oscar/Certification