Provider Demographics
NPI:1841412293
Name:CHRISTENSEN, MARY BETH (PA)
Entity Type:Individual
Prefix:
First Name:MARY
Middle Name:BETH
Last Name:CHRISTENSEN
Suffix:
Gender:F
Credentials:PA
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Other - First Name:
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Other - Last Name:
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Mailing Address - Street 1:28963 LITTLE MACK
Mailing Address - Street 2:SUITE 101
Mailing Address - City:ST. CLAIR
Mailing Address - State:MI
Mailing Address - Zip Code:48081
Mailing Address - Country:US
Mailing Address - Phone:586-447-0700
Mailing Address - Fax:586-498-0707
Practice Address - Street 1:28963 LITTLE MACK AVE
Practice Address - Street 2:SUITE 101
Practice Address - City:SAINT CLAIR SHORES
Practice Address - State:MI
Practice Address - Zip Code:48081-3017
Practice Address - Country:US
Practice Address - Phone:586-447-0700
Practice Address - Fax:586-447-0707
Is Sole Proprietor?:No
Enumeration Date:2007-05-03
Last Update Date:2019-05-15
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
MI002160363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
MIS07139Medicare UPIN