Healthcare Provider Details

I. General information

NPI: 1801156161
Provider Name (Legal Business Name): JENNIFER RUTH CHRISTENSON D.O.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/21/2012
Last Update Date: 01/18/2021
Certification Date: 01/18/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1900 WOODLAND DR
COOS BAY OR
97420-2099
US

IV. Provider business mailing address

1900 WOODLAND DR
COOS BAY OR
97420-2099
US

V. Phone/Fax

Practice location:
  • Phone: 541-267-5151
  • Fax: 407-425-5203
Mailing address:
  • Phone: 541-267-5151
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207YX0007X
TaxonomyPlastic Surgery within the Head & Neck (Otolaryngology) Physician
License NumberOS15571
License Number StateFL
# 2
Primary TaxonomyN
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number State
# 3
Primary TaxonomyY
Taxonomy Code207YX0007X
TaxonomyPlastic Surgery within the Head & Neck (Otolaryngology) Physician
License NumberDO181810
License Number StateOR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: