Individual
MISS CHRISTINA MARIE PERGRAM
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
PA-C
Contact information
Practice address
1250 RLASTON AVE, SUITE 104, DEFIANCE, OH 43512
(419) 785-3281
(419) 784-1606
Mailing address
1250 RLASTON AVE, SUITE 104, DEFIANCE, OH 43512
(419) 785-3281
(419) 784-1606
Taxonomy
Speciality
Code
Description
License number
State
363A00000X
Physician Assistant
Primary
50.002104
OH
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
0069721
—
OH
Enumeration date
11/11/2008
Last updated
05/21/2013
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