Provider Demographics
NPI:1801060645
Name:WHITAKER, CHRISTINE (PA-C)
Entity type:Individual
Prefix:MRS
First Name:CHRISTINE
Middle Name:
Last Name:WHITAKER
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 1:2868 WILLIAMETTE ST #100
Mailing Address - Street 2:VILLAGE HEALTH CLINIC
Mailing Address - City:EUGENE
Mailing Address - State:OR
Mailing Address - Zip Code:97405
Mailing Address - Country:US
Mailing Address - Phone:541-684-3988
Mailing Address - Fax:541-686-2279
Practice Address - Street 1:2868 WILLIAMETTE ST #100
Practice Address - Street 2:VILLAGE HEALTH CLINIC
Practice Address - City:EUGENE
Practice Address - State:OR
Practice Address - Zip Code:97405
Practice Address - Country:US
Practice Address - Phone:541-684-3988
Practice Address - Fax:541-686-2279
Is Sole Proprietor?:No
Enumeration Date:2008-04-14
Last Update Date:2011-05-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ORPA000263363AM0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical
Provider Identifiers
StateIdentifier IDID TypeIssuer
ORPA000263OtherLICENSE