MEDICARE: CAROL A. CHRISTIANSON M.S.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	170300000X	Genetic Counselor (M.S.)

General Provider Information

NPI Number	:	1073502605
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	CAROL A. CHRISTIANSON M.S.

Provider Business Mailing Address
First Line	:	200 N PARK ST
Second Line	:
City	:	KALAMAZOO
State	:	MI
Zip	:	49007-3731
Country	:	US
Telephone Number	:	269-373-0120
Fax Number	:	269-373-0108

Provider Business Practice Location Address
First Line	:	200 N PARK ST
Second Line	:
City	:	KALAMAZOO
State	:	MI
Zip	:	49007-3731
Country	:	US
Telephone Number	:	269-373-0120
Fax Number	:	269-373-0108

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	10/17/2005
Last Update Date	:	01/06/2012

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