Provider Demographics
NPI:1568448520
Name:CHRISTENSEN, HUGH (PA)
Entity Type:Individual
Prefix:
First Name:HUGH
Middle Name:
Last Name:CHRISTENSEN
Suffix:
Gender:M
Credentials:PA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:13101 N ORACLE RD
Mailing Address - Street 2:169
Mailing Address - City:TUCSON
Mailing Address - State:AZ
Mailing Address - Zip Code:85739-9554
Mailing Address - Country:US
Mailing Address - Phone:520-825-0300
Mailing Address - Fax:520-825-0047
Practice Address - Street 1:13101 N ORACLE RD
Practice Address - Street 2:169
Practice Address - City:TUCSON
Practice Address - State:AZ
Practice Address - Zip Code:85739-9554
Practice Address - Country:US
Practice Address - Phone:520-825-0300
Practice Address - Fax:520-825-0047
Is Sole Proprietor?:Yes
Enumeration Date:2005-12-21
Last Update Date:2015-03-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ1858363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZ392665Medicaid
AZ392665Medicaid
AZS60858Medicare UPIN