Provider Demographics
NPI:1215509500
Name:LASSEN, CHRISTIE
Entity type:Individual
Prefix:
First Name:CHRISTIE
Middle Name:
Last Name:LASSEN
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:71150 ORCHARD CROSSING LN
Mailing Address - Street 2:
Mailing Address - City:ROMEO
Mailing Address - State:MI
Mailing Address - Zip Code:48065-3644
Mailing Address - Country:US
Mailing Address - Phone:586-336-0102
Mailing Address - Fax:586-336-0106
Practice Address - Street 1:ORCHARD GROVE HEALTH CAMPUS
Practice Address - Street 2:71150 ORCHARD CROSSING LANE
Practice Address - City:ROMEO
Practice Address - State:MI
Practice Address - Zip Code:48065
Practice Address - Country:US
Practice Address - Phone:586-336-0102
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-07-15
Last Update Date:2021-07-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI4704328637163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse