Provider Demographics
NPI:1598577207
Name:CHRISTENSEN, KATHRYN J
Entity type:Individual
Prefix:
First Name:KATHRYN
Middle Name:J
Last Name:CHRISTENSEN
Suffix:
Gender:F
Credentials:
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 1058
Mailing Address - Street 2:
Mailing Address - City:IMPERIAL
Mailing Address - State:NE
Mailing Address - Zip Code:69033-1058
Mailing Address - Country:US
Mailing Address - Phone:308-883-0640
Mailing Address - Fax:
Practice Address - Street 1:139 YUCCA DR # 1058
Practice Address - Street 2:
Practice Address - City:IMPERIAL
Practice Address - State:NE
Practice Address - Zip Code:69033-2068
Practice Address - Country:US
Practice Address - Phone:308-883-0640
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2025-01-21
Last Update Date:2025-01-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NE3747P1801X
NE444044253747P1801X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3747P1801XNursing Service Related ProvidersTechnicianPersonal Care Attendant