Provider Demographics
NPI:1689028094
Name:CHRISTENSEN, SHEADEN
Entity Type:Individual
Prefix:
First Name:SHEADEN
Middle Name:
Last Name:CHRISTENSEN
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 1:1801 MONKS AVE APT 721D
Mailing Address - Street 2:
Mailing Address - City:MANKATO
Mailing Address - State:MN
Mailing Address - Zip Code:56001-6376
Mailing Address - Country:US
Mailing Address - Phone:952-826-9203
Mailing Address - Fax:
Practice Address - Street 1:1801 MONKS AVE APT 721D
Practice Address - Street 2:
Practice Address - City:MANKATO
Practice Address - State:MN
Practice Address - Zip Code:56001-6376
Practice Address - Country:US
Practice Address - Phone:952-826-9203
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2016-04-21
Last Update Date:2016-04-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program