MEDICARE: KNACHELL 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	104100000X	Social Worker	4537-S	NV

General Provider Information

NPI Number	:	1487873055
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	KNACHELL CHRISTENSEN

Provider Business Mailing Address
First Line	:	3032 WATERVIEW DR
Second Line	:
City	:	LAS VEGAS
State	:	NV
Zip	:	89117-2324
Country	:	US
Telephone Number	:	702-217-7602
Fax Number	:

Provider Business Practice Location Address
First Line	:	3032 WATERVIEW DR
Second Line	:
City	:	LAS VEGAS
State	:	NV
Zip	:	89117-2324
Country	:	US
Telephone Number	:	702-217-7602
Fax Number	:

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

Provider Enumeration Date	:	04/24/2007
Last Update Date	:	07/09/2007

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Directions to “ KNACHELL CHRISTENSEN ” Practice Location

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