Provider Demographics
NPI:1366214272
Name:CHRISTENSEN, TYSEN JUNE (RDN)
Entity type:Individual
Prefix:MRS
First Name:TYSEN
Middle Name:JUNE
Last Name:CHRISTENSEN
Suffix:
Gender:F
Credentials:RDN
Other - Prefix:MISS
Other - First Name:TYSEN
Other - Middle Name:JUNE
Other - Last Name:CULLEN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:RDN
Mailing Address - Street 1:56542 CASCADE VIEW DR
Mailing Address - Street 2:
Mailing Address - City:WARREN
Mailing Address - State:OR
Mailing Address - Zip Code:97053-9739
Mailing Address - Country:US
Mailing Address - Phone:541-404-3260
Mailing Address - Fax:
Practice Address - Street 1:56542 CASCADE VIEW DR
Practice Address - Street 2:
Practice Address - City:WARREN
Practice Address - State:OR
Practice Address - Zip Code:97053-9739
Practice Address - Country:US
Practice Address - Phone:541-404-3260
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-10-24
Last Update Date:2023-10-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ORLD-D-1022198133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, RegisteredGroup - Single Specialty