Provider Demographics
NPI:1508526351
Name:CHRISTENSEN, PHYLLIS M (RN)
Entity Type:Individual
Prefix:
First Name:PHYLLIS
Middle Name:M
Last Name:CHRISTENSEN
Suffix:
Gender:F
Credentials:RN
Other - Prefix:
Other - First Name:PHYLLIS
Other - Middle Name:MARIE
Other - Last Name:HOENSTINE
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:RN
Mailing Address - Street 1:1016 N DREXEL AVE
Mailing Address - Street 2:
Mailing Address - City:INDIANAPOLIS
Mailing Address - State:IN
Mailing Address - Zip Code:46201-2702
Mailing Address - Country:US
Mailing Address - Phone:317-965-6924
Mailing Address - Fax:
Practice Address - Street 1:800 PRUDENTIAL DR
Practice Address - Street 2:
Practice Address - City:JACKSONVILLE
Practice Address - State:FL
Practice Address - Zip Code:32207-8211
Practice Address - Country:US
Practice Address - Phone:904-202-2000
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-12-21
Last Update Date:2021-12-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN28181085A163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse