Provider Demographics
NPI:1588379077
Name:CHRISTENSON, MAKENZIE TAYLOR (RDN)
Entity type:Individual
Prefix:
First Name:MAKENZIE
Middle Name:TAYLOR
Last Name:CHRISTENSON
Suffix:
Gender:F
Credentials:RDN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:49 LITTRELL DR
Mailing Address - Street 2:
Mailing Address - City:BELLA VISTA
Mailing Address - State:AR
Mailing Address - Zip Code:72714-2702
Mailing Address - Country:US
Mailing Address - Phone:303-250-3075
Mailing Address - Fax:
Practice Address - Street 1:49 LITTRELL DR
Practice Address - Street 2:
Practice Address - City:BELLA VISTA
Practice Address - State:AR
Practice Address - Zip Code:72714-2702
Practice Address - Country:US
Practice Address - Phone:303-250-3075
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-01-18
Last Update Date:2023-01-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
86175994133V00000X
AR2343133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered