Provider Demographics
NPI:1790330454
Name:CHRISTENSEN, MICHAEL REY (PA)
Entity Type:Individual
Prefix:
First Name:MICHAEL
Middle Name:REY
Last Name:CHRISTENSEN
Suffix:
Gender:M
Credentials:PA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2363 E NEWCASTLE DR
Mailing Address - Street 2:
Mailing Address - City:SANDY
Mailing Address - State:UT
Mailing Address - Zip Code:84093-1735
Mailing Address - Country:US
Mailing Address - Phone:801-558-2070
Mailing Address - Fax:
Practice Address - Street 1:3556 W 9800 S STE 101
Practice Address - Street 2:
Practice Address - City:SOUTH JORDAN
Practice Address - State:UT
Practice Address - Zip Code:84095-3221
Practice Address - Country:US
Practice Address - Phone:801-567-9780
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-08-08
Last Update Date:2019-08-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT11363234363AM0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical