Provider Demographics
NPI:1164450375
Name:CHRISTENSEN, KATIE S (NP)
Entity Type:Individual
Prefix:
First Name:KATIE
Middle Name:S
Last Name:CHRISTENSEN
Suffix:
Gender:F
Credentials:NP
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 3867
Mailing Address - Street 2:
Mailing Address - City:SPOKANE
Mailing Address - State:WA
Mailing Address - Zip Code:99220-3867
Mailing Address - Country:US
Mailing Address - Phone:509-688-6700
Mailing Address - Fax:509-688-6777
Practice Address - Street 1:3010 S SOUTHEAST BLVD
Practice Address - Street 2:STE A
Practice Address - City:SPOKANE
Practice Address - State:WA
Practice Address - Zip Code:99223-3541
Practice Address - Country:US
Practice Address - Phone:509-688-6700
Practice Address - Fax:509-688-6777
Is Sole Proprietor?:No
Enumeration Date:2006-06-28
Last Update Date:2015-12-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IDN-29564363L00000X
IDNP487A363L00000X
WAAP30005734363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
Provider Identifiers
StateIdentifier IDID TypeIssuer
ID805964500Medicaid
WA1003851Medicaid
ID805964500Medicaid
WAG8938920Medicare PIN