Provider Demographics
NPI:1215367685
Name:CHRISTENSEN, LADESSA MARIE (NP-C)
Entity type:Individual
Prefix:
First Name:LADESSA
Middle Name:MARIE
Last Name:CHRISTENSEN
Suffix:
Gender:F
Credentials:NP-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4664 N PENNGROVE WAY STE 100
Mailing Address - Street 2:
Mailing Address - City:MERIDIAN
Mailing Address - State:ID
Mailing Address - Zip Code:83646-7442
Mailing Address - Country:US
Mailing Address - Phone:208-898-7467
Mailing Address - Fax:208-398-2120
Practice Address - Street 1:4664 N PENNGROVE WAY STE 100
Practice Address - Street 2:
Practice Address - City:MERIDIAN
Practice Address - State:ID
Practice Address - Zip Code:83646-7442
Practice Address - Country:US
Practice Address - Phone:208-898-7467
Practice Address - Fax:208-398-2120
Is Sole Proprietor?:No
Enumeration Date:2013-11-20
Last Update Date:2021-11-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR201600702363L00000X
WAAP60628138363LF0000X
UT5173942-8900363LF0000X
UT5173942-4405363LF0000X
ID68154363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
No363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner