MEDICARE: VANESSA CHRISTENSEN

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	2255A2300X	Athletic Trainer	25MT00141700	NJ

General Provider Information

NPI Number	:	1417117748
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	VANESSA CHRISTENSEN

Provider Business Mailing Address
First Line	:	76 ALLEN AVE
Second Line	:
City	:	MANASQUAN
State	:	NJ
Zip	:	08736-3426
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	400 CEDAR AVE
Second Line	:
City	:	WEST LONG BRANCH
State	:	NJ
Zip	:	07764-1804
Country	:	US
Telephone Number	:	732-571-4473
Fax Number	:

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

Provider Enumeration Date	:	06/10/2008
Last Update Date	:	06/10/2008

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Directions to “ VANESSA CHRISTENSEN ” Practice Location

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