Provider Demographics
NPI:1598847667
Name:CHRISTENSEN, GLEN ERMAN (MD)
Entity Type:Individual
Prefix:DR
First Name:GLEN
Middle Name:ERMAN
Last Name:CHRISTENSEN
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
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Other - Credentials:
Mailing Address - Street 1:5539 S 27TH ST
Mailing Address - Street 2:SUITE 206
Mailing Address - City:LINCOLN
Mailing Address - State:NE
Mailing Address - Zip Code:68512-1611
Mailing Address - Country:US
Mailing Address - Phone:402-423-3600
Mailing Address - Fax:402-423-3690
Practice Address - Street 1:5539 S 27TH ST
Practice Address - Street 2:SUITE 206
Practice Address - City:LINCOLN
Practice Address - State:NE
Practice Address - Zip Code:68512-1611
Practice Address - Country:US
Practice Address - Phone:402-423-3600
Practice Address - Fax:402-423-3690
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-19
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
NE132042084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry
Provider Identifiers
StateIdentifier IDID TypeIssuer
NEB67966Medicare UPIN
NE095978Medicare ID - Type Unspecified