Provider Demographics
NPI:1366507592
Name:CHRISTENSEN, RICHARD E (PA)
Entity Type:Individual
Prefix:
First Name:RICHARD
Middle Name:E
Last Name:CHRISTENSEN
Suffix:
Gender:M
Credentials:PA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3825 N 24TH ST
Mailing Address - Street 2:
Mailing Address - City:PHOENIX
Mailing Address - State:AZ
Mailing Address - Zip Code:85016-6512
Mailing Address - Country:US
Mailing Address - Phone:602-248-8886
Mailing Address - Fax:602-248-8999
Practice Address - Street 1:3825 N 24TH ST
Practice Address - Street 2:
Practice Address - City:PHOENIX
Practice Address - State:AZ
Practice Address - Zip Code:85016-6512
Practice Address - Country:US
Practice Address - Phone:602-248-8886
Practice Address - Fax:602-248-8999
Is Sole Proprietor?:No
Enumeration Date:2006-12-27
Last Update Date:2016-05-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ1010363AM0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical