MEDICARE: COLLEEN CHRISTOPHERSEN

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	374J00000X	Doula		MI

General Provider Information

NPI Number	:	1689497406
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	COLLEEN CHRISTOPHERSEN

Provider Business Mailing Address
First Line	:	1627 SUNSET DR
Second Line	:
City	:	NORTH MUSKEGON
State	:	MI
Zip	:	49445-3075
Country	:	US
Telephone Number	:	231-557-2649
Fax Number	:

Provider Business Practice Location Address
First Line	:	1627 SUNSET DR
Second Line	:
City	:	NORTH MUSKEGON
State	:	MI
Zip	:	49445-3075
Country	:	US
Telephone Number	:	231-557-2649
Fax Number	:

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

Provider Enumeration Date	:	11/01/2024
Last Update Date	:	11/01/2024

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Directions to “ COLLEEN CHRISTOPHERSEN ” Practice Location

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