Provider Demographics
NPI:1780200139
Name:CHRISTENSEN, EMILY RAE (APRN)
Entity Type:Individual
Prefix:
First Name:EMILY
Middle Name:RAE
Last Name:CHRISTENSEN
Suffix:
Gender:F
Credentials:APRN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1050 TWIN FORKS LN
Mailing Address - Street 2:
Mailing Address - City:SAINT PAUL
Mailing Address - State:NE
Mailing Address - Zip Code:68873-3616
Mailing Address - Country:US
Mailing Address - Phone:308-750-4774
Mailing Address - Fax:
Practice Address - Street 1:2620 W FAIDLEY AVE
Practice Address - Street 2:
Practice Address - City:GRAND ISLAND
Practice Address - State:NE
Practice Address - Zip Code:68803-4205
Practice Address - Country:US
Practice Address - Phone:308-750-4774
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-06-22
Last Update Date:2020-06-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NE113168363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
NE113168OtherNEBRASKA STATE LICENSE-APRN