Healthcare Provider Details

I. General information

NPI: 1982326195
Provider Name (Legal Business Name): CHRISTOPHER TODD MICHAELSEN RN
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/14/2022
Last Update Date: 05/04/2023
Certification Date: 05/04/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3643 N ROXBORO ST
DURHAM NC
27704-2702
US

IV. Provider business mailing address

107 MEADOW BROOK LN
OXFORD NC
27565-2870
US

V. Phone/Fax

Practice location:
  • Phone: 919-470-6474
  • Fax:
Mailing address:
  • Phone: 828-713-0310
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code163WP0808X
TaxonomyPsychiatric/Mental Health Registered Nurse
License Number244049
License Number StateNC
# 2
Primary TaxonomyY
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License Number5017797
License Number StateNC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: