Healthcare Provider Details

I. General information

NPI: 1831016930
Provider Name (Legal Business Name): STEPHANIE M CHRISTENSEN APRN
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/30/2026
Last Update Date: 06/30/2026
Certification Date: 07/01/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3155 CHANNING WAY STE A
IDAHO FALLS ID
83404-7875
US

IV. Provider business mailing address

1551 W 200 N
BLACKFOOT ID
83221-5006
US

V. Phone/Fax

Practice location:
  • Phone: 208-522-6044
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number1981014
License Number StateID

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: