Provider Demographics
NPI:1689794182
Name:CHRISTENSEN, PAMELA CAROL (FNP)
Entity Type:Individual
Prefix:MRS
First Name:PAMELA
Middle Name:CAROL
Last Name:CHRISTENSEN
Suffix:
Gender:F
Credentials:FNP
Other - Prefix:MRS
Other - First Name:PAMELA
Other - Middle Name:CAROL
Other - Last Name:REINKOESTER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:FNP
Mailing Address - Street 1:3465 S 4155 W
Mailing Address - Street 2:#2
Mailing Address - City:WEST VALLEY CITY
Mailing Address - State:UT
Mailing Address - Zip Code:84120-2076
Mailing Address - Country:US
Mailing Address - Phone:801-963-7636
Mailing Address - Fax:
Practice Address - Street 1:3465 PIONEER PKWY
Practice Address - Street 2:STE 2
Practice Address - City:WEST VALLEY CITY
Practice Address - State:UT
Practice Address - Zip Code:84120-2076
Practice Address - Country:US
Practice Address - Phone:801-963-7636
Practice Address - Fax:801-963-8130
Is Sole Proprietor?:No
Enumeration Date:2007-03-29
Last Update Date:2007-07-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT200408-4405363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
UTS70645Medicare UPIN