Provider Demographics
NPI:1659851871
Name:CHRISTENSEN, LAURIE (RN)
Entity Type:Individual
Prefix:
First Name:LAURIE
Middle Name:
Last Name:CHRISTENSEN
Suffix:
Gender:F
Credentials:RN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8711 MAPLECREST DR
Mailing Address - Street 2:
Mailing Address - City:MT PLEASANT
Mailing Address - State:WI
Mailing Address - Zip Code:53406-3117
Mailing Address - Country:US
Mailing Address - Phone:414-587-3128
Mailing Address - Fax:
Practice Address - Street 1:8711 MAPLECREST DR
Practice Address - Street 2:
Practice Address - City:MT PLEASANT
Practice Address - State:WI
Practice Address - Zip Code:53406-3117
Practice Address - Country:US
Practice Address - Phone:414-587-3128
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-08-16
Last Update Date:2018-08-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI94899163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse