Provider Demographics
NPI:1487082178
Name:HUELSKAMP, MARIA CHRISTINE (PA-C)
Entity type:Individual
Prefix:MRS
First Name:MARIA
Middle Name:CHRISTINE
Last Name:HUELSKAMP
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:MISS
Other - First Name:MARIA
Other - Middle Name:CHRISTINE
Other - Last Name:KUEHL
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PA-C
Mailing Address - Street 1:PO BOX 39
Mailing Address - Street 2:
Mailing Address - City:WAPAKONETA
Mailing Address - State:OH
Mailing Address - Zip Code:45895-0039
Mailing Address - Country:US
Mailing Address - Phone:419-738-3317
Mailing Address - Fax:
Practice Address - Street 1:1015 S BLACKHOOF ST
Practice Address - Street 2:
Practice Address - City:WAPAKONETA
Practice Address - State:OH
Practice Address - Zip Code:45895
Practice Address - Country:US
Practice Address - Phone:419-738-3317
Practice Address - Fax:419-738-5952
Is Sole Proprietor?:No
Enumeration Date:2013-10-16
Last Update Date:2018-08-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH50.003903363AM0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH0123289Medicaid