Provider Demographics
NPI:1689806531
Name:PURDUM, CHRISTA M (PA)
Entity type:Individual
Prefix:
First Name:CHRISTA
Middle Name:M
Last Name:PURDUM
Suffix:
Gender:
Credentials:PA
Other - Prefix:
Other - First Name:CHRISTA
Other - Middle Name:M
Other - Last Name:OLIVER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:ONE GI CREDENTIALING DEPARTMENT
Mailing Address - Street 2:PO BOX 381468
Mailing Address - City:GERMANTOWN
Mailing Address - State:TN
Mailing Address - Zip Code:38183-1468
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:8640 SUDLEY RD STE 201
Practice Address - Street 2:
Practice Address - City:MANASSAS
Practice Address - State:VA
Practice Address - Zip Code:20110-4404
Practice Address - Country:US
Practice Address - Phone:703-368-6819
Practice Address - Fax:703-330-2923
Is Sole Proprietor?:No
Enumeration Date:2009-08-11
Last Update Date:2025-02-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0110003057363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant