Healthcare Provider Details

I. General information

NPI: 1730265752
Provider Name (Legal Business Name): NICOLE ANN CHRISTENSON M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

Provider Other Name: NICOLE ANN CHRISTENSON-KEISACKER M.D.

II. Dates (important events)

Enumeration Date: 10/31/2006
Last Update Date: 10/11/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4400 W 69TH ST STE 1500
SIOUX FALLS SD
57108-8170
US

IV. Provider business mailing address

PO BOX 86370
SIOUX FALLS SD
57118-6370
US

V. Phone/Fax

Practice location:
  • Phone: 605-322-5735
  • Fax: 605-322-5736
Mailing address:
  • Phone: 605-322-7510
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2084P0804X
TaxonomyChild & Adolescent Psychiatry Physician
License Number7012
License Number StateSD

VII. Legacy identifiers

For crosswalk purposes, the following legacy (non-NPI) identifiers are available for this provider:

# 1
Identifier255968
Identifier TypeOTHER
Identifier State
Identifier IssuerMIDLAND'S CHOICE
# 2
IdentifierSD7012
Identifier TypeOTHER
Identifier StateSD
Identifier IssuerSOUTH DAKOTA LICENSE
# 3
Identifier7101990
Identifier TypeMEDICAID
Identifier StateSD
Identifier Issuer
# 4
Identifier7012
Identifier TypeOTHER
Identifier StateSD
Identifier IssuerDAKOTACARE

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: