Healthcare Provider Details

I. General information

NPI: 1538087804
Provider Name (Legal Business Name): JACE T CHRISTENSEN
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/06/2026
Last Update Date: 07/06/2026
Certification Date: 07/06/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1515 E COLUMBIA ST
OTHELLO WA
99344-1846
US

IV. Provider business mailing address

PO BOX 82
ROYAL CITY WA
99357-0082
US

V. Phone/Fax

Practice location:
  • Phone: 509-488-5256
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License NumberRN.RN.61286228.MSL
License Number StateWA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: