Provider Demographics
NPI:1093753469
Name:CHRISTENSEN, TRISTY L (MD)
Entity Type:Individual
Prefix:DR
First Name:TRISTY
Middle Name:L
Last Name:CHRISTENSEN
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:PO BOX 27128
Mailing Address - Street 2:
Mailing Address - City:SALT LAKE CITY
Mailing Address - State:UT
Mailing Address - Zip Code:84127-0128
Mailing Address - Country:US
Mailing Address - Phone:800-748-4248
Mailing Address - Fax:435-283-4078
Practice Address - Street 1:525 N MAIN ST
Practice Address - Street 2:
Practice Address - City:EPHRAIM
Practice Address - State:UT
Practice Address - Zip Code:84627-1155
Practice Address - Country:US
Practice Address - Phone:435-283-4076
Practice Address - Fax:435-283-4078
Is Sole Proprietor?:No
Enumeration Date:2006-06-04
Last Update Date:2010-06-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT49801611205207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
UT000063181Medicare PIN
UTH26540Medicare UPIN
UT000055844Medicare PIN