MEDICARE: MR. BRANT R CHRISTENSEN AU.D.

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	231HA2400X	Assistive Technology Practitioner Audiologist	A963	WY
2	231HA2500X	Assistive Technology Supplier Audiologist	A963	WY
3	237600000X	Audiologist-Hearing Aid Fitter	A963	WY
4	231H00000X	Audiologist	A-963	WY

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1285639807
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MR. BRANT R CHRISTENSEN AU.D.

Provider Business Mailing Address
First Line	:	PO BOX 21804
Second Line	:
City	:	CHEYENNE
State	:	WY
Zip	:	82003-7073
Country	:	US
Telephone Number	:	307-426-4327
Fax Number	:	307-426-3277

Provider Business Practice Location Address
First Line	:	7215 COMMONS CIR UNIT C
Second Line	:
City	:	CHEYENNE
State	:	WY
Zip	:	82009-2666
Country	:	US
Telephone Number	:	307-426-4327
Fax Number	:	307-426-3277

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

Provider Enumeration Date	:	06/20/2005
Last Update Date	:	10/16/2020

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