Healthcare Provider Details

I. General information

NPI: 1326256769
Provider Name (Legal Business Name): ARDYS LOUISE CHRISTENSON RNC, IBCLC
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/18/2007
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

14730 55TH ST NE
SAINT MICHAEL MN
55376-3278
US

IV. Provider business mailing address

14730 55TH ST NE
SAINT MICHAEL MN
55376-3278
US

V. Phone/Fax

Practice location:
  • Phone: 763-497-5045
  • Fax:
Mailing address:
  • Phone: 763-497-5045
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163WL0100X
TaxonomyLactation Consultant (Registered Nurse)
License NumberR053462-8
License Number StateMN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: