Healthcare Provider Details

I. General information

NPI: 1770634842
Provider Name (Legal Business Name): MARY J CHRISTENSEN M.S.N., A.P.N.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/16/2007
Last Update Date: 09/29/2026
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

885 ROOSEVELT RD
GLEN ELLYN IL
60137-6141
US

IV. Provider business mailing address

885 ROOSEVELT RD
GLEN ELLYN IL
60137-6141
US

V. Phone/Fax

Practice location:
  • Phone: 630-790-1555
  • Fax: 630-545-3787
Mailing address:
  • Phone: 630-790-1555
  • Fax: 630-545-3787

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License Number209005290
License Number StateIL
# 2
Primary TaxonomyN
Taxonomy Code363LP2300X
TaxonomyPrimary Care Nurse Practitioner
License Number209.005290
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: