Provider Demographics
NPI:1851504393
Name:CHRISTENSEN, SUE ANN R (CPNP)
Entity Type:Individual
Prefix:MS
First Name:SUE ANN
Middle Name:R
Last Name:CHRISTENSEN
Suffix:
Gender:F
Credentials:CPNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1055 N 300 W STE 410
Mailing Address - Street 2:
Mailing Address - City:PROVO
Mailing Address - State:UT
Mailing Address - Zip Code:84604-3354
Mailing Address - Country:US
Mailing Address - Phone:801-357-7883
Mailing Address - Fax:801-357-7975
Practice Address - Street 1:1055 N 300 W
Practice Address - Street 2:SUITE 410
Practice Address - City:PROVO
Practice Address - State:UT
Practice Address - Zip Code:84604-3344
Practice Address - Country:US
Practice Address - Phone:801-357-7883
Practice Address - Fax:801-357-7975
Is Sole Proprietor?:No
Enumeration Date:2007-05-08
Last Update Date:2007-07-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT216783-4405363LP0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPediatrics