Provider Demographics
NPI:1245342336
Name:CHRISTIANSEN, CARRIE HELEN (NURSE PRACTITIONER)
Entity type:Individual
Prefix:MISS
First Name:CARRIE
Middle Name:HELEN
Last Name:CHRISTIANSEN
Suffix:
Gender:F
Credentials:NURSE PRACTITIONER
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1500 DUARTE RD
Mailing Address - Street 2:
Mailing Address - City:DUARTE
Mailing Address - State:CA
Mailing Address - Zip Code:91010-3012
Mailing Address - Country:US
Mailing Address - Phone:626-471-9200
Mailing Address - Fax:626-930-5402
Practice Address - Street 1:1500 DUARTE RD
Practice Address - Street 2:
Practice Address - City:DUARTE
Practice Address - State:CA
Practice Address - Zip Code:91010-3012
Practice Address - Country:US
Practice Address - Phone:626-471-9200
Practice Address - Fax:626-930-5402
Is Sole Proprietor?:No
Enumeration Date:2006-08-31
Last Update Date:2014-09-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CANP15960363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAWNP15960AMedicare PIN
CAWNP15960CMedicare PIN
CAWNP15960BMedicare PIN
CAWNP15960DMedicare PIN