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General NPI Number Information
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NPI Number | 1215367685
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Entity Type | Individual
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Provider Name | LADESSA MARIE CHRISTENSEN NP-C
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Gender | Female
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Dates
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Enumeration Date | 11/20/2013
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Last Update Date | 11/29/2021
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Provider Practice Location Address
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Address Line | 4664 N PENNGROVE WAY STE 100
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City | MERIDIAN
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State | ID
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Zip | 83646-7442
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Country | US
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Telephone | 208-898-7467
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Fax | 208-398-2120
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Provider Business Mailing Address
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Address Line | 4664 N PENNGROVE WAY STE 100
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City | MERIDIAN
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State | ID
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Zip | 83646-7442
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Country | US
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Telephone | 208-898-7467
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Fax | 208-398-2120
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 363L00000X
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Taxonomy Name | Nurse Practitioner
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License Number | 201600702
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License Number State | OR
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Taxonomy #2
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Taxonomy Code | 363LF0000X
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Taxonomy Name | Family Nurse Practitioner
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License Number | AP60628138
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License Number State | WA
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Taxonomy #3
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Taxonomy Code | 363LF0000X
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Taxonomy Name | Family Nurse Practitioner
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License Number | 5173942-8900
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License Number State | UT
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Taxonomy #4
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Taxonomy Code | 363LF0000X
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Taxonomy Name | Family Nurse Practitioner
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License Number | 5173942-4405
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License Number State | UT
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Taxonomy #5
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Taxonomy Code | 363LF0000X
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Taxonomy Name | Family Nurse Practitioner
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License Number | 68154
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License Number State | ID
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