Provider Demographics
NPI:1528019064
Name:CHRISTEN, GLEN STANLEY (MD)
Entity Type:Individual
Prefix:
First Name:GLEN
Middle Name:STANLEY
Last Name:CHRISTEN
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9621 RIDGETOP BLVD NW
Mailing Address - Street 2:
Mailing Address - City:SILVERDALE
Mailing Address - State:WA
Mailing Address - Zip Code:98383-8502
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:1780 NW MYHRE RD
Practice Address - Street 2:SUITE 2120
Practice Address - City:SILVERDALE
Practice Address - State:WA
Practice Address - Zip Code:98383-8676
Practice Address - Country:US
Practice Address - Phone:360-782-3100
Practice Address - Fax:360-782-3112
Is Sole Proprietor?:No
Enumeration Date:2006-05-12
Last Update Date:2023-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAMD00027251207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & Gynecology
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA75425OtherLABOR & INDUSTRIES
1160015840OtherRAILROAD MEDICARE
WA8117723Medicaid
1236CHOtherREGENCE
4586499OtherAETNA
4586499OtherAETNA
1160015840OtherRAILROAD MEDICARE
WAG115136409Medicare PIN
1236CHOtherREGENCE
WA8117723Medicaid
WAGAB05413Medicare PIN
WAGAB17273Medicare PIN
G8898592Medicare PIN
WAGAB25322Medicare PIN
WAG000250628Medicare PIN