Provider Demographics
NPI:1386728129
Name:JOHNSEN, CHRISTINE MARY (NP, CNS, APRN-BC)
Entity type:Individual
Prefix:
First Name:CHRISTINE
Middle Name:MARY
Last Name:JOHNSEN
Suffix:
Gender:F
Credentials:NP, CNS, APRN-BC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:87 6TH ST
Mailing Address - Street 2:
Mailing Address - City:CAMBRIDGE
Mailing Address - State:MA
Mailing Address - Zip Code:02141-2014
Mailing Address - Country:US
Mailing Address - Phone:617-492-2896
Mailing Address - Fax:
Practice Address - Street 1:20 EASTBROOK RD
Practice Address - Street 2:
Practice Address - City:DEDHAM
Practice Address - State:MA
Practice Address - Zip Code:02026-2075
Practice Address - Country:US
Practice Address - Phone:781-329-9365
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-25
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA199217363LA2200X, 364SP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Not Answered363LA2200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAdult Health
Not Answered364SP0808XPhysician Assistants & Advanced Practice Nursing ProvidersClinical Nurse SpecialistPsychiatric/Mental Health