Provider Demographics
NPI:1851526487
Name:CHRISTOFFERSEN, MICHAEL A
Entity Type:Individual
Prefix:
First Name:MICHAEL
Middle Name:A
Last Name:CHRISTOFFERSEN
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5715 LUNSFORD DR
Mailing Address - Street 2:APT H
Mailing Address - City:CHEYENNE
Mailing Address - State:WY
Mailing Address - Zip Code:82001-6074
Mailing Address - Country:US
Mailing Address - Phone:307-274-0605
Mailing Address - Fax:307-638-0467
Practice Address - Street 1:5715 LUNSFORD DR
Practice Address - Street 2:APT H
Practice Address - City:CHEYENNE
Practice Address - State:WY
Practice Address - Zip Code:82001-6074
Practice Address - Country:US
Practice Address - Phone:307-274-0605
Practice Address - Fax:307-638-0467
Is Sole Proprietor?:Yes
Enumeration Date:2009-05-27
Last Update Date:2009-05-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171M00000XOther Service ProvidersCase Manager/Care Coordinator