Provider Demographics
NPI:1659350015
Name:CHRISTENSEN, AMY ELLIS (MD)
Entity Type:Individual
Prefix:
First Name:AMY
Middle Name:ELLIS
Last Name:CHRISTENSEN
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3325 RESEARCH WAY
Mailing Address - Street 2:
Mailing Address - City:CARSON CITY
Mailing Address - State:NV
Mailing Address - Zip Code:89706-7913
Mailing Address - Country:US
Mailing Address - Phone:775-888-6610
Mailing Address - Fax:
Practice Address - Street 1:3900 CAMBRIDGE ST
Practice Address - Street 2:SUITE 102
Practice Address - City:LAS VEGAS
Practice Address - State:NV
Practice Address - Zip Code:89119-7439
Practice Address - Country:US
Practice Address - Phone:702-307-5415
Practice Address - Fax:702-307-5416
Is Sole Proprietor?:No
Enumeration Date:2006-01-13
Last Update Date:2016-12-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ27027208000000X
NV16698208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
NV1659350015Medicaid
AZ385650Medicaid
AZG55290Medicare UPIN