Healthcare Provider Details

I. General information

NPI: 1861368367
Provider Name (Legal Business Name): SAMANTHA D CHRISTIANSEN BS
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/13/2025
Last Update Date: 12/29/2025
Certification Date: 12/29/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1514 G ST
LEWISTON ID
83501-2017
US

IV. Provider business mailing address

419 22ND AVE
LEWISTON ID
83501-3812
US

V. Phone/Fax

Practice location:
  • Phone: 208-816-6078
  • Fax: 208-413-6772
Mailing address:
  • Phone: 208-816-6078
  • Fax: 208-413-6772

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code106S00000X
TaxonomyBehavior Technician
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: