Provider Demographics
NPI:1275340788
Name:CHRISTENSEN, STEPHEN JOEL
Entity type:Individual
Prefix:
First Name:STEPHEN
Middle Name:JOEL
Last Name:CHRISTENSEN
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4159 S BOISEN LOOP
Mailing Address - Street 2:
Mailing Address - City:COEUR D ALENE
Mailing Address - State:ID
Mailing Address - Zip Code:83814-7798
Mailing Address - Country:US
Mailing Address - Phone:541-326-9899
Mailing Address - Fax:
Practice Address - Street 1:4159 S BOISEN LOOP
Practice Address - Street 2:
Practice Address - City:COEUR D ALENE
Practice Address - State:ID
Practice Address - Zip Code:83814-7798
Practice Address - Country:US
Practice Address - Phone:541-326-9899
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-12-17
Last Update Date:2024-12-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program