Provider Demographics
NPI:1659904985
Name:CHRISTIANSEN, AARON
Entity Type:Individual
Prefix:MR
First Name:AARON
Middle Name:
Last Name:CHRISTIANSEN
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:21659A SONGBIRD DR
Mailing Address - Street 2:
Mailing Address - City:CHUGIAK
Mailing Address - State:AK
Mailing Address - Zip Code:99567-5615
Mailing Address - Country:US
Mailing Address - Phone:907-373-1000
Mailing Address - Fax:888-588-5194
Practice Address - Street 1:21659A SONGBIRD DR
Practice Address - Street 2:
Practice Address - City:CHUGIAK
Practice Address - State:AK
Practice Address - Zip Code:99567-5615
Practice Address - Country:US
Practice Address - Phone:907-373-1000
Practice Address - Fax:888-588-5194
Is Sole Proprietor?:No
Enumeration Date:2020-02-14
Last Update Date:2020-02-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AKCCCERT111171M00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171M00000XOther Service ProvidersCase Manager/Care Coordinator
Provider Identifiers
StateIdentifier IDID TypeIssuer
AKCCCERT111Medicaid