Provider Demographics
NPI:1952668048
Name:CHRISTIANSEN, PETER ARTHUR
Entity Type:Individual
Prefix:
First Name:PETER
Middle Name:ARTHUR
Last Name:CHRISTIANSEN
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 1:2922 N 1200 EAST RD
Mailing Address - Street 2:
Mailing Address - City:CLIFTON
Mailing Address - State:IL
Mailing Address - Zip Code:60927-7104
Mailing Address - Country:US
Mailing Address - Phone:815-383-2993
Mailing Address - Fax:
Practice Address - Street 1:1215 LEE ST
Practice Address - Street 2:BOX #800212
Practice Address - City:CHARLOTTESVILLE
Practice Address - State:VA
Practice Address - Zip Code:22908-0816
Practice Address - Country:US
Practice Address - Phone:434-922-3244
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2012-04-13
Last Update Date:2021-11-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program