MEDICARE: MICHAEL CHRISTENSEN ACNP

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	363LA2100X	Acute Care Nurse Practitioner	AP4660	AZ
2	363LA2100X	Acute Care Nurse Practitioner	8339822-4405	UT

General Provider Information

NPI Number	:	1003162215
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MICHAEL CHRISTENSEN ACNP

Provider Business Mailing Address
First Line	:	5802 S 900 E UNIT 1
Second Line	:
City	:	MURRAY
State	:	UT
Zip	:	84121-1644
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	5802 S 900 E UNIT 1
Second Line	:
City	:	MURRAY
State	:	UT
Zip	:	84121-1644
Country	:	US
Telephone Number	:	480-868-9650
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	07/25/2012
Last Update Date	:	06/01/2020

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