Provider Demographics
NPI:1578899399
Name:CHRISTENSON, ELIZABETH RUTH STREY (PA-C)
Entity Type:Individual
Prefix:MRS
First Name:ELIZABETH
Middle Name:RUTH STREY
Last Name:CHRISTENSON
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:MISS
Other - First Name:ELIZABETH
Other - Middle Name:RUTH
Other - Last Name:STREY
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:6510 KENILWORTH AVE STE 2400
Mailing Address - Street 2:
Mailing Address - City:RIVERDALE
Mailing Address - State:MD
Mailing Address - Zip Code:20737-1346
Mailing Address - Country:US
Mailing Address - Phone:301-927-2711
Mailing Address - Fax:
Practice Address - Street 1:6510 KENILWORTH AVE STE 2400
Practice Address - Street 2:
Practice Address - City:RIVERDALE
Practice Address - State:MD
Practice Address - Zip Code:20737-1346
Practice Address - Country:US
Practice Address - Phone:301-927-2711
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2009-10-29
Last Update Date:2011-03-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDC0004061363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant