Provider Demographics
NPI:1104837897
Name:CHRISTENSEN, JENNIFER J (DPM)
Entity Type:Individual
Prefix:DR
First Name:JENNIFER
Middle Name:J
Last Name:CHRISTENSEN
Suffix:
Gender:F
Credentials:DPM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:182 THOMAS JOHNSON DR
Mailing Address - Street 2:SUITE 203
Mailing Address - City:FREDERICK
Mailing Address - State:MD
Mailing Address - Zip Code:21702-4407
Mailing Address - Country:US
Mailing Address - Phone:310-695-9527
Mailing Address - Fax:301-695-0403
Practice Address - Street 1:182 THOMAS JOHNSON DR
Practice Address - Street 2:SUITE 203
Practice Address - City:FREDERICK
Practice Address - State:MD
Practice Address - Zip Code:21702-4407
Practice Address - Country:US
Practice Address - Phone:310-695-9527
Practice Address - Fax:301-695-0403
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-10
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD01386213E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes213E00000XPodiatric Medicine & Surgery Service ProvidersPodiatrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
MDU98111Medicare UPIN