Healthcare Provider Details

I. General information

NPI: 1497378749
Provider Name (Legal Business Name): NATHANAEL COOK CHRISTENSEN DO
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/21/2020
Last Update Date: 07/01/2026
Certification Date: 07/01/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

801 W MAPLE ST
FARMINGTON NM
87401-5630
US

IV. Provider business mailing address

801 W MAPLE ST
FARMINGTON NM
87401-5630
US

V. Phone/Fax

Practice location:
  • Phone: 505-609-2000
  • Fax: 505-609-2472
Mailing address:
  • Phone: 505-609-2000
  • Fax: 505-609-2472

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207ZP0102X
TaxonomyAnatomic Pathology & Clinical Pathology Physician
License NumberDO2025-0109
License Number StateNM
# 2
Primary TaxonomyN
Taxonomy Code207ZP0102X
TaxonomyAnatomic Pathology & Clinical Pathology Physician
License NumberR-11834
License Number StateIA
# 3
Primary TaxonomyN
Taxonomy Code207ZP0102X
TaxonomyAnatomic Pathology & Clinical Pathology Physician
License NumberDO-06730
License Number StateIA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: