Provider Demographics
NPI:1558725465
Name:CHRISTENSEN, KATIE LYNN (BSN, RN, IBCLC)
Entity Type:Individual
Prefix:MRS
First Name:KATIE
Middle Name:LYNN
Last Name:CHRISTENSEN
Suffix:
Gender:F
Credentials:BSN, RN, IBCLC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:671 ESCALANTE DR
Mailing Address - Street 2:
Mailing Address - City:ST GEORGE
Mailing Address - State:UT
Mailing Address - Zip Code:84790-7605
Mailing Address - Country:US
Mailing Address - Phone:435-764-2057
Mailing Address - Fax:
Practice Address - Street 1:671 ESCALANTE DR
Practice Address - Street 2:
Practice Address - City:ST GEORGE
Practice Address - State:UT
Practice Address - Zip Code:84790-7605
Practice Address - Country:US
Practice Address - Phone:435-764-2057
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-04-06
Last Update Date:2016-04-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT6976790-3102163WL0100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WL0100XNursing Service ProvidersRegistered NurseLactation Consultant