Provider Demographics
NPI:1043294234
Name:CHRISTENSEN, W PHIL (AUD)
Entity Type:Individual
Prefix:
First Name:W
Middle Name:PHIL
Last Name:CHRISTENSEN
Suffix:
Gender:M
Credentials:AUD
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 336080
Mailing Address - Street 2:
Mailing Address - City:N LAS VEGAS
Mailing Address - State:NV
Mailing Address - Zip Code:89033-6080
Mailing Address - Country:US
Mailing Address - Phone:702-853-7986
Mailing Address - Fax:702-880-1511
Practice Address - Street 1:9080 W CHEYENNE AVE STE 110
Practice Address - Street 2:
Practice Address - City:LAS VEGAS
Practice Address - State:NV
Practice Address - Zip Code:89129-8932
Practice Address - Country:US
Practice Address - Phone:702-853-7986
Practice Address - Fax:702-880-1511
Is Sole Proprietor?:No
Enumeration Date:2005-12-01
Last Update Date:2011-03-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NVA-012231H00000X
NV155237700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes231H00000XSpeech, Language and Hearing Service ProvidersAudiologist
No237700000XSpeech, Language and Hearing Service ProvidersHearing Instrument Specialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NVV101515Medicare PIN
NVDA293ZMedicare PIN