MEDICARE: AMY ELLIS CHRISTENSEN MD

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	208000000X	Pediatrics Physician	27027	AZ
2	208000000X	Pediatrics Physician	16698	NV

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
2	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1659350015
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	AMY ELLIS CHRISTENSEN MD

Provider Business Mailing Address
First Line	:	3325 RESEARCH WAY
Second Line	:
City	:	CARSON CITY
State	:	NV
Zip	:	89706-7913
Country	:	US
Telephone Number	:	775-888-6610
Fax Number	:

Provider Business Practice Location Address
First Line	:	3900 CAMBRIDGE ST
Second Line	:	SUITE 102
City	:	LAS VEGAS
State	:	NV
Zip	:	89119-7439
Country	:	US
Telephone Number	:	702-307-5415
Fax Number	:	702-307-5416

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

Provider Enumeration Date	:	01/13/2006
Last Update Date	:	12/28/2016

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Directions to “ AMY ELLIS CHRISTENSEN MD” Practice Location

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