Provider Demographics
NPI:1396378972
Name:CHRISTENSEN, DIANNE DORTHY (MS)
Entity Type:Individual
Prefix:
First Name:DIANNE
Middle Name:DORTHY
Last Name:CHRISTENSEN
Suffix:
Gender:F
Credentials:MS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1510 MENAUL BLVD NW
Mailing Address - Street 2:
Mailing Address - City:ALBUQUERQUE
Mailing Address - State:NM
Mailing Address - Zip Code:87107-1026
Mailing Address - Country:US
Mailing Address - Phone:505-243-1386
Mailing Address - Fax:505-243-1545
Practice Address - Street 1:1510 MENAUL BLVD NW
Practice Address - Street 2:
Practice Address - City:ALBUQUERQUE
Practice Address - State:NM
Practice Address - Zip Code:87107-1026
Practice Address - Country:US
Practice Address - Phone:505-243-1386
Practice Address - Fax:505-243-1545
Is Sole Proprietor?:No
Enumeration Date:2020-02-21
Last Update Date:2020-02-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174H00000XOther Service ProvidersHealth Educator