Healthcare Provider Details

I. General information

NPI: 1194637694
Provider Name (Legal Business Name): CASEY CHRISTIANSON L.P.N.
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/19/2026
Last Update Date: 09/19/2026
Certification Date: 09/19/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

200 UNIVERSITY AVE E
SAINT PAUL MN
55101-2507
US

IV. Provider business mailing address

22499 COYOUR RD
FREDERIC WI
54837-9201
US

V. Phone/Fax

Practice location:
  • Phone: 800-719-4040
  • Fax:
Mailing address:
  • Phone: 715-690-4541
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code164W00000X
TaxonomyLicensed Practical Nurse
License Number827893
License Number StateMN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: