Provider Demographics
NPI:1720415904
Name:CHRISTENSEN, JEFFREY LYLE (CRNA)
Entity Type:Individual
Prefix:
First Name:JEFFREY
Middle Name:LYLE
Last Name:CHRISTENSEN
Suffix:
Gender:M
Credentials:CRNA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:201 PRESIDENTS CIR RM 411
Mailing Address - Street 2:
Mailing Address - City:SALT LAKE CITY
Mailing Address - State:UT
Mailing Address - Zip Code:84112-9022
Mailing Address - Country:US
Mailing Address - Phone:801-587-4803
Mailing Address - Fax:
Practice Address - Street 1:201 PRESIDENTS CIR RM 411
Practice Address - Street 2:
Practice Address - City:SALT LAKE CITY
Practice Address - State:UT
Practice Address - Zip Code:84112-9022
Practice Address - Country:US
Practice Address - Phone:801-587-4803
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-10-02
Last Update Date:2021-11-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZCRNA0966367500000X
UT5052812-4406367500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367500000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Anesthetist, Certified Registered