=====================================================
General NPI Number Information
=====================================================
NPI Number | 1750873436
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | KENDALL CHRISTENSEN FNP
-----------------------------------------------------
Gender | Female
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 05/30/2018
-----------------------------------------------------
Last Update Date | 01/28/2021
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 454 WELCH ST
-----------------------------------------------------
City | SILVERTON
-----------------------------------------------------
State | OR
-----------------------------------------------------
Zip | 97381-1934
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 503-873-1540
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | PO BOX 3417
-----------------------------------------------------
City | PORTLAND
-----------------------------------------------------
State | OR
-----------------------------------------------------
Zip | 97208-3417
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 503-814-4400
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 363LF0000X
-----------------------------------------------------
Taxonomy Name | Family Nurse Practitioner
-----------------------------------------------------
License Number | 201803720NP-PP
-----------------------------------------------------
License Number State | OR
-----------------------------------------------------