Provider Demographics
NPI:1417585050
Name:CHRISTENSEN, ERIC JAMES
Entity Type:Individual
Prefix:
First Name:ERIC
Middle Name:JAMES
Last Name:CHRISTENSEN
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:BUILDING 99
Mailing Address - Street 2:MISAWA AIR BASE
Mailing Address - City:MISAWA
Mailing Address - State:AOMORI
Mailing Address - Zip Code:96319
Mailing Address - Country:JP
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:BUILDING 99
Practice Address - Street 2:MISAWA AIR BASE
Practice Address - City:MISAWA
Practice Address - State:AOMORI
Practice Address - Zip Code:96319
Practice Address - Country:JP
Practice Address - Phone:315-226-6161
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-03-30
Last Update Date:2022-04-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171000000XOther Service ProvidersMilitary Health Care Provider