Provider Demographics
NPI:1467561613
Name:CHRISTENSEN, TANYA E (MD)
Entity Type:Individual
Prefix:DR
First Name:TANYA
Middle Name:E
Last Name:CHRISTENSEN
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 1:390 N MAIN
Mailing Address - Street 2:
Mailing Address - City:BOUNTIFUL
Mailing Address - State:UT
Mailing Address - Zip Code:84010-6046
Mailing Address - Country:US
Mailing Address - Phone:801-299-9050
Mailing Address - Fax:801-299-9051
Practice Address - Street 1:390 N MAIN ST
Practice Address - Street 2:
Practice Address - City:BOUNTIFUL
Practice Address - State:UT
Practice Address - Zip Code:84010-6046
Practice Address - Country:US
Practice Address - Phone:801-299-9050
Practice Address - Fax:801-299-9051
Is Sole Proprietor?:No
Enumeration Date:2006-08-30
Last Update Date:2012-09-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY253337207N00000X
UT372740-1205207N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207N00000XAllopathic & Osteopathic PhysiciansDermatology