Healthcare Provider Details

I. General information

NPI: 1023194008
Provider Name (Legal Business Name): CYNTHIA LYNN CHRISTENSON
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/31/2006
Last Update Date: 02/19/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

12055 CHURCH ST
BIRCH RUN MI
48415-8758
US

IV. Provider business mailing address

12055 CHURCH ST
BIRCH RUN MI
48415-8758
US

V. Phone/Fax

Practice location:
  • Phone: 989-624-7230
  • Fax: 989-624-7231
Mailing address:
  • Phone: 989-624-7230
  • Fax: 989-624-7231

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code332BC3200X
TaxonomyCustomized Equipment (DME)
License Number540G302880
License Number StateMI

VIII. Authorized Official

Name: MR. MICHAEL ANTHONY CHRISTENSON SR.
Title or Position: OWNER
Credential: ATP
Phone: 989-624-7230