Provider Demographics
NPI:1912976259
Name:CHRISTIANSEN, AMMIE E (DO)
Entity type:Individual
Prefix:DR
First Name:AMMIE
Middle Name:E
Last Name:CHRISTIANSEN
Suffix:
Gender:F
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:601 S MAIN ST
Mailing Address - Street 2:
Mailing Address - City:LONGMONT
Mailing Address - State:CO
Mailing Address - Zip Code:80501-6427
Mailing Address - Country:US
Mailing Address - Phone:720-718-8410
Mailing Address - Fax:720-718-8999
Practice Address - Street 1:601 S MAIN ST
Practice Address - Street 2:
Practice Address - City:LONGMONT
Practice Address - State:CO
Practice Address - Zip Code:80501-6427
Practice Address - Country:US
Practice Address - Phone:720-718-8410
Practice Address - Fax:720-718-8999
Is Sole Proprietor?:No
Enumeration Date:2006-03-17
Last Update Date:2022-02-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CODR.0044616207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
CO75378761Medicaid
COC806715Medicare PIN
CO75378761Medicaid