Provider Demographics
NPI:1528068525
Name:CHRISTIANSEN, ELLEN M (MSN, FNP)
Entity type:Individual
Prefix:MS
First Name:ELLEN
Middle Name:M
Last Name:CHRISTIANSEN
Suffix:
Gender:F
Credentials:MSN, FNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 910
Mailing Address - Street 2:
Mailing Address - City:POINT REYES STATION
Mailing Address - State:CA
Mailing Address - Zip Code:94956-0910
Mailing Address - Country:US
Mailing Address - Phone:415-663-8666
Mailing Address - Fax:415-663-9532
Practice Address - Street 1:3 SIXTH STREET
Practice Address - Street 2:
Practice Address - City:POINT REYES STATION
Practice Address - State:CA
Practice Address - Zip Code:94956-0910
Practice Address - Country:US
Practice Address - Phone:415-663-8666
Practice Address - Fax:415-663-9532
Is Sole Proprietor?:Not Answered
Enumeration Date:2005-08-01
Last Update Date:2023-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA512169/10681163WG0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WG0000XNursing Service ProvidersRegistered NurseGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA10681OtherNP LICENSE
CARN 512169OtherRN LICENSE
CARN 512169OtherRN LICENSE