Provider Demographics
NPI:1518178342
Name:CHRISTENSEN, NINA PHAM (OD)
Entity Type:Individual
Prefix:
First Name:NINA
Middle Name:PHAM
Last Name:CHRISTENSEN
Suffix:
Gender:F
Credentials:OD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2205 N CALHOUN RD
Mailing Address - Street 2:STE 16
Mailing Address - City:BROOKFIELD
Mailing Address - State:WI
Mailing Address - Zip Code:53005-5062
Mailing Address - Country:US
Mailing Address - Phone:262-204-1061
Mailing Address - Fax:
Practice Address - Street 1:950 N PORT WASHINGTON RD
Practice Address - Street 2:
Practice Address - City:GRAFTON
Practice Address - State:WI
Practice Address - Zip Code:53024-9201
Practice Address - Country:US
Practice Address - Phone:262-204-1063
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-05-24
Last Update Date:2021-04-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI2803-035152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
WI38609900Medicaid
WIU80815Medicare UPIN