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General NPI Number Information
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NPI Number | 1801156161
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Entity Type | Individual
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Provider Name | JENNIFER RUTH CHRISTENSON D.O.
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Gender | Female
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Dates
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Enumeration Date | 05/21/2012
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Last Update Date | 01/18/2021
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Provider Practice Location Address
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Address Line | 1900 WOODLAND DR
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City | COOS BAY
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State | OR
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Zip | 97420-2099
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Country | US
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Telephone | 541-267-5151
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Fax | 407-425-5203
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Provider Business Mailing Address
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Address Line | 1900 WOODLAND DR
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City | COOS BAY
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State | OR
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Zip | 97420-2099
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Country | US
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Telephone | 541-267-5151
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Fax |
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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 | 207YX0007X
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Taxonomy Name | Plastic Surgery within the Head & Neck (Otolaryngology) Physician
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License Number | OS15571
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License Number State | FL
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Taxonomy #2
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Taxonomy Code | 390200000X
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Taxonomy Name | Student in an Organized Health Care Education/Training Program
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License Number |
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License Number State |
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Taxonomy #3
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Taxonomy Code | 207YX0007X
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Taxonomy Name | Plastic Surgery within the Head & Neck (Otolaryngology) Physician
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License Number | DO181810
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License Number State | OR
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