Provider Demographics
NPI:1063099315
Name:CHRISTENSEN, HEIDI LAURA EVANS (NAC AND HCA)
Entity type:Individual
Prefix:
First Name:HEIDI
Middle Name:LAURA EVANS
Last Name:CHRISTENSEN
Suffix:
Gender:F
Credentials:NAC AND HCA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:22855 E COUNTRY VISTA DR UNIT 506
Mailing Address - Street 2:
Mailing Address - City:LIBERTY LAKE
Mailing Address - State:WA
Mailing Address - Zip Code:99019-5029
Mailing Address - Country:US
Mailing Address - Phone:509-288-9940
Mailing Address - Fax:
Practice Address - Street 1:22855 E COUNTRY VISTA DR UNIT 506
Practice Address - Street 2:
Practice Address - City:LIBERTY LAKE
Practice Address - State:WA
Practice Address - Zip Code:99019-5029
Practice Address - Country:US
Practice Address - Phone:509-288-9940
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-03-24
Last Update Date:2021-03-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAHM60892414374U00000X
WANC60922222376K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes376K00000XNursing Service Related ProvidersNurse's Aide
No374U00000XNursing Service Related ProvidersHome Health Aide