Provider Demographics
NPI:1073040234
Name:CHRISTIANSEN, MARYANNE EILEEN (PA-C)
Entity Type:Individual
Prefix:MS
First Name:MARYANNE
Middle Name:EILEEN
Last Name:CHRISTIANSEN
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:MS
Other - First Name:MARYANN
Other - Middle Name:EILEEN
Other - Last Name:CHRISTIANSEN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:133 PLEASANT STREET
Mailing Address - Street 2:
Mailing Address - City:BERLIN
Mailing Address - State:NH
Mailing Address - Zip Code:03570
Mailing Address - Country:US
Mailing Address - Phone:603-752-2040
Mailing Address - Fax:
Practice Address - Street 1:2 BROADWAY STREET
Practice Address - Street 2:
Practice Address - City:GORHAM
Practice Address - State:NH
Practice Address - Zip Code:03581
Practice Address - Country:US
Practice Address - Phone:603-466-2741
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-05-18
Last Update Date:2017-05-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NH1255363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant