Provider Demographics
NPI:1306394085
Name:CHRISTENSEN, ALICE
Entity Type:Individual
Prefix:
First Name:ALICE
Middle Name:
Last Name:CHRISTENSEN
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1638 MARGARET AVE SE
Mailing Address - Street 2:
Mailing Address - City:GRAND RAPIDS
Mailing Address - State:MI
Mailing Address - Zip Code:49507-2230
Mailing Address - Country:US
Mailing Address - Phone:616-885-6416
Mailing Address - Fax:616-245-3456
Practice Address - Street 1:1638 MARGARET AVE SE
Practice Address - Street 2:
Practice Address - City:GRAND RAPIDS
Practice Address - State:MI
Practice Address - Zip Code:49507-2230
Practice Address - Country:US
Practice Address - Phone:616-885-6416
Practice Address - Fax:616-245-3456
Is Sole Proprietor?:Yes
Enumeration Date:2016-09-12
Last Update Date:2016-09-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI4704133074163WL0100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WL0100XNursing Service ProvidersRegistered NurseLactation Consultant