Healthcare Provider Details

I. General information

NPI: 1003866765
Provider Name (Legal Business Name): CHRISTINA R BJORNSTAD M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/11/2006
Last Update Date: 04/16/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

625 6TH AVE
LEWISTON ID
83501-9999
US

IV. Provider business mailing address

625 6TH AVE
LEWISTON ID
83501-9999
US

V. Phone/Fax

Practice location:
  • Phone: 208-743-8226
  • Fax: 208-746-2069
Mailing address:
  • Phone: 208-743-8226
  • Fax: 208-746-2069

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207QA0505X
TaxonomyAdult Medicine Physician
License NumberM3283
License Number StateID

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: