Provider Demographics
NPI:1124048012
Name:CHRISTENSEN, EVAN H (CRNA)
Entity type:Individual
Prefix:
First Name:EVAN
Middle Name:H
Last Name:CHRISTENSEN
Suffix:
Gender:M
Credentials:CRNA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1400 E LEONA RD
Mailing Address - Street 2:
Mailing Address - City:UVALDE
Mailing Address - State:TX
Mailing Address - Zip Code:78801-4866
Mailing Address - Country:US
Mailing Address - Phone:801-673-3072
Mailing Address - Fax:
Practice Address - Street 1:1025 GARNER FIELD RD
Practice Address - Street 2:
Practice Address - City:UVALDE
Practice Address - State:TX
Practice Address - Zip Code:78801-4809
Practice Address - Country:US
Practice Address - Phone:830-278-6251
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-07-20
Last Update Date:2012-02-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT343983-4406367500000X
TX793080367500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367500000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Anesthetist, Certified Registered
Provider Identifiers
StateIdentifier IDID TypeIssuer
UT245816OtherALTIUS
UT25078OtherHEALTHY U
UT34398344000001OtherFEDERAL BLUE CROSS
UT34398344000001OtherHEALTHWISE
UT34398344000001OtherBLUE CROSS-2
UT8401401924EVEOtherEDUCATORS MUTUAL
UT84794OtherPEHP
UT34398344000001OtherVALUECARE
UTQMP000003334770OtherMOLINA
UT005586321OtherNAS MEDICARE NORIDIAN
WY121617100Medicaid
UT841870OtherDESERET MUTUAL
UTQMP000003334770OtherMOLINA