Provider Demographics
NPI:1265647697
Name:CHRISTENSEN, DIANE LYNN (RT)
Entity Type:Individual
Prefix:MS
First Name:DIANE
Middle Name:LYNN
Last Name:CHRISTENSEN
Suffix:
Gender:F
Credentials:RT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1836 S 221ST DR
Mailing Address - Street 2:
Mailing Address - City:BUCKEYE
Mailing Address - State:AZ
Mailing Address - Zip Code:85326-8529
Mailing Address - Country:US
Mailing Address - Phone:805-990-4260
Mailing Address - Fax:
Practice Address - Street 1:12033 AGENCY RD
Practice Address - Street 2:
Practice Address - City:PARKER
Practice Address - State:AZ
Practice Address - Zip Code:85344-7718
Practice Address - Country:US
Practice Address - Phone:928-669-3380
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-05-11
Last Update Date:2011-06-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZCRT-12676247100000X
NMRRT 3630247100000X
CARHM 72399247100000X, 2471M2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes247100000XTechnologists, Technicians & Other Technical Service ProvidersRadiologic Technologist
No2471M2300XTechnologists, Technicians & Other Technical Service ProvidersRadiologic TechnologistMammography