Provider Demographics
NPI:1043406051
Name:CHRISTENSON, CARLA SUE (BSOT)
Entity Type:Individual
Prefix:
First Name:CARLA
Middle Name:SUE
Last Name:CHRISTENSON
Suffix:
Gender:F
Credentials:BSOT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:985459 NEBRASKA MEDICAL CTR
Mailing Address - Street 2:
Mailing Address - City:OMAHA
Mailing Address - State:NE
Mailing Address - Zip Code:68198-5459
Mailing Address - Country:US
Mailing Address - Phone:402-559-8943
Mailing Address - Fax:
Practice Address - Street 1:985459 NEBRASKA MEDICAL CTR
Practice Address - Street 2:
Practice Address - City:OMAHA
Practice Address - State:NE
Practice Address - Zip Code:68198-5459
Practice Address - Country:US
Practice Address - Phone:402-559-8943
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-09-24
Last Update Date:2007-09-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NE919174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NE919Medicaid