Basic Information
Provider Information
NPI: 1720059454
EntityType: 1
ReplacementNPI:  
OrganizationName:  
LastName: SWITZER
FirstName: CHRISTA
MiddleName:  
NamePrefix:  
NameSuffix:  
Credential: PA
OtherOrganizationName:  
OtherOrganizationType:  
OtherLastName:  
OtherFirstName:  
OtherMiddleName:  
OtherNamePrefix:  
OtherNameSuffix:  
OtherCredential:  
OtherLastNameType:  
Mailing Information
Address1: 6255 SHERIDAN DRIVE
Address2: SUITE 304
City: WILLIAMSVILLE
State: NY
PostalCode: 142214825
CountryCode: US
TelephoneNumber: 7168578666
FaxNumber: 7166301054
Practice Location
Address1: 9 LIMESTONE DR
Address2:  
City: WILLIAMSVILLE
State: NY
PostalCode: 142217051
CountryCode: US
TelephoneNumber: 7166312517
FaxNumber: 7166345650
Other Information
ProviderEnumerationDate: 01/31/2006
LastUpdateDate: 02/08/2010
NPIDeactivationReasonCode:  
NPIDeactivationDate:  
NPIReactivationDate:  
ProviderGenderCode: F
AuthorizedOfficialLastName:  
AuthorizedOfficialFirstName:  
AuthorizedOfficialMiddleName:  
AuthorizedOfficialTitleorPosition:  
AuthorizedOfficialTelephone:  
IsSoleProprietor: N
IsOrganizationSubpart:  
ParentOrganizationLBN:  
AuthorizedOfficialNamePrefix:  
AuthorizedOfficialNameSuffix:  
AuthorizedOfficialCredential:  
NPICertificationDate:  

Taxonomy Information
TaxonomyLicenseStateSwitchTaxonomyGroupTaxonomyTypeTaxonomyClassSubSpecialty
363A00000X0093751NYY Physician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant 

No ID Information.


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