Provider Demographics
NPI:1801190988
Name:CHRISTENSEN, CAROL LEE (NP-C)
Entity Type:Individual
Prefix:MRS
First Name:CAROL
Middle Name:LEE
Last Name:CHRISTENSEN
Suffix:
Gender:F
Credentials:NP-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:30 W MCCREIGHT AVE
Mailing Address - Street 2:STE 211
Mailing Address - City:SPRINGFIELD
Mailing Address - State:OH
Mailing Address - Zip Code:45504-1842
Mailing Address - Country:US
Mailing Address - Phone:937-325-3696
Mailing Address - Fax:937-325-9859
Practice Address - Street 1:30 W MCCREIGHT AVE
Practice Address - Street 2:STE 211
Practice Address - City:SPRINGFIELD
Practice Address - State:OH
Practice Address - Zip Code:45504-1842
Practice Address - Country:US
Practice Address - Phone:937-325-3696
Practice Address - Fax:937-325-9859
Is Sole Proprietor?:Yes
Enumeration Date:2011-01-04
Last Update Date:2016-09-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH260020163W00000X, 363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
No163W00000XNursing Service ProvidersRegistered Nurse