Healthcare Provider Details

I. General information

NPI: 1568796472
Provider Name (Legal Business Name): DAVID L CHRISTENSEN
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/24/2009
Last Update Date: 09/24/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

312 W 4TH ST NEW RIVER CORPORATION
CARSON CITY NV
89703
US

IV. Provider business mailing address

PO BOX 1903
SEWARD AK
99664-1903
US

V. Phone/Fax

Practice location:
  • Phone: 775-555-5555
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code146N00000X
TaxonomyBasic Emergency Medical Technician
License Number08015003
License Number StateAK

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: