Provider Demographics
NPI:1275797284
Name:CHRISTIANSON, JUDITH E (MD)
Entity Type:Individual
Prefix:DR
First Name:JUDITH
Middle Name:E
Last Name:CHRISTIANSON
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 1:220 N 6TH AVE E
Mailing Address - Street 2:
Mailing Address - City:DULUTH
Mailing Address - State:MN
Mailing Address - Zip Code:55805-1952
Mailing Address - Country:US
Mailing Address - Phone:218-249-7000
Mailing Address - Fax:218-249-7050
Practice Address - Street 1:220 N 6TH AVE E
Practice Address - Street 2:
Practice Address - City:DULUTH
Practice Address - State:MN
Practice Address - Zip Code:55805-1952
Practice Address - Country:US
Practice Address - Phone:218-249-7000
Practice Address - Fax:218-249-7050
Is Sole Proprietor?:No
Enumeration Date:2008-07-18
Last Update Date:2020-12-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN610582084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL009572600Medicaid
FLHN925YMedicare PIN
FLHN925ZMedicare PIN