Provider Demographics
NPI:1659134930
Name:CHRISTENSEN, CRYSTAL MARIE (RN)
Entity Type:Individual
Prefix:
First Name:CRYSTAL
Middle Name:MARIE
Last Name:CHRISTENSEN
Suffix:
Gender:F
Credentials:RN
Other - Prefix:
Other - First Name:CRYSTAL
Other - Middle Name:MARIE
Other - Last Name:SIDNER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:PO BOX 161
Mailing Address - Street 2:
Mailing Address - City:ALEXANDER
Mailing Address - State:ND
Mailing Address - Zip Code:58831-0161
Mailing Address - Country:US
Mailing Address - Phone:701-580-8437
Mailing Address - Fax:
Practice Address - Street 1:1321 W DAKOTA PKWY
Practice Address - Street 2:
Practice Address - City:WILLISTON
Practice Address - State:ND
Practice Address - Zip Code:58801-3807
Practice Address - Country:US
Practice Address - Phone:701-572-7711
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-01-31
Last Update Date:2024-01-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NDR48013163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse