Provider Demographics
NPI:1639479157
Name:CHRISTIANSON, JAMIE NICOLE (RDH, LAP)
Entity Type:Individual
Prefix:
First Name:JAMIE
Middle Name:NICOLE
Last Name:CHRISTIANSON
Suffix:
Gender:F
Credentials:RDH, LAP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4805 SPRING MEADOW AVE
Mailing Address - Street 2:
Mailing Address - City:EUGENE
Mailing Address - State:OR
Mailing Address - Zip Code:97404-3350
Mailing Address - Country:US
Mailing Address - Phone:541-603-4510
Mailing Address - Fax:
Practice Address - Street 1:4805 SPRING MEADOW AVE
Practice Address - Street 2:
Practice Address - City:EUGENE
Practice Address - State:OR
Practice Address - Zip Code:97404-3350
Practice Address - Country:US
Practice Address - Phone:541-603-4510
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-11-01
Last Update Date:2010-11-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ORH5097124Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes124Q00000XDental ProvidersDental Hygienist