Healthcare Provider Details

I. General information

NPI: 1801190988
Provider Name (Legal Business Name): CAROL LEE CHRISTENSEN NP-C
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 01/04/2011
Last Update Date: 09/23/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

30 W MCCREIGHT AVE STE 211
SPRINGFIELD OH
45504-1842
US

IV. Provider business mailing address

30 W MCCREIGHT AVE STE 211
SPRINGFIELD OH
45504-1842
US

V. Phone/Fax

Practice location:
  • Phone: 937-325-3696
  • Fax: 937-325-9859
Mailing address:
  • Phone: 937-325-3696
  • Fax: 937-325-9859

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License Number260020
License Number StateOH
# 2
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number260020
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: