Provider Demographics
NPI:1053666123
Name:CHRISTENSEN, LANCE (PA)
Entity Type:Individual
Prefix:
First Name:LANCE
Middle Name:
Last Name:CHRISTENSEN
Suffix:
Gender:M
Credentials:PA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:201 S CLINTON ST STE 195
Mailing Address - Street 2:
Mailing Address - City:IOWA CITY
Mailing Address - State:IA
Mailing Address - Zip Code:52240-4023
Mailing Address - Country:US
Mailing Address - Phone:319-384-0520
Mailing Address - Fax:319-384-0603
Practice Address - Street 1:201 S CLINTON ST STE 195
Practice Address - Street 2:
Practice Address - City:IOWA CITY
Practice Address - State:IA
Practice Address - Zip Code:52240-4023
Practice Address - Country:US
Practice Address - Phone:319-384-0520
Practice Address - Fax:319-384-0603
Is Sole Proprietor?:No
Enumeration Date:2012-07-16
Last Update Date:2012-07-16
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
IA002316363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant