Provider Demographics
NPI:1003866765
Name:BJORNSTAD, CHRISTINA R (MD)
Entity Type:Individual
Prefix:DR
First Name:CHRISTINA
Middle Name:R
Last Name:BJORNSTAD
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:625 6TH AVE
Mailing Address - Street 2:
Mailing Address - City:LEWISTON
Mailing Address - State:ID
Mailing Address - Zip Code:83501-9999
Mailing Address - Country:US
Mailing Address - Phone:208-743-8226
Mailing Address - Fax:208-746-2069
Practice Address - Street 1:625 6TH AVE
Practice Address - Street 2:
Practice Address - City:LEWISTON
Practice Address - State:ID
Practice Address - Zip Code:83501-9999
Practice Address - Country:US
Practice Address - Phone:208-743-8226
Practice Address - Fax:208-746-2069
Is Sole Proprietor?:Yes
Enumeration Date:2006-05-11
Last Update Date:2008-04-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IDM3283207QA0505X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207QA0505XAllopathic & Osteopathic PhysiciansFamily MedicineAdult Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA1083807Medicaid
ID0267250001Medicare NSC
ID1109955Medicare PIN
IDB63233Medicare UPIN