Provider Demographics
NPI:1184720666
Name:CHRISTIANSON, DARCY E (PA)
Entity type:Individual
Prefix:
First Name:DARCY
Middle Name:E
Last Name:CHRISTIANSON
Suffix:
Gender:F
Credentials:PA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 5010
Mailing Address - Street 2:
Mailing Address - City:MINOT
Mailing Address - State:ND
Mailing Address - Zip Code:58702-5010
Mailing Address - Country:US
Mailing Address - Phone:701-857-5650
Mailing Address - Fax:701-857-5031
Practice Address - Street 1:1500-24TH AVE. S.W.
Practice Address - Street 2:
Practice Address - City:MINOT
Practice Address - State:ND
Practice Address - Zip Code:58701-6905
Practice Address - Country:US
Practice Address - Phone:701-857-5150
Practice Address - Fax:701-857-5564
Is Sole Proprietor?:No
Enumeration Date:2006-09-15
Last Update Date:2015-10-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NDPAC0155363A00000X
MN1402363A00000X
MN10736363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
MNP00937245OtherRAILROAD MEDICARE
NDS12661Medicare UPIN
ND23794Medicare PIN
MN970004752Medicare PIN