Provider Demographics
NPI:1255430625
Name:CHRISTENSEN, STACY E (NP)
Entity type:Individual
Prefix:
First Name:STACY
Middle Name:E
Last Name:CHRISTENSEN
Suffix:
Gender:F
Credentials:NP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:16 NUTMEG CIR
Mailing Address - Street 2:
Mailing Address - City:WETHERSFIELD
Mailing Address - State:CT
Mailing Address - Zip Code:06109-4056
Mailing Address - Country:US
Mailing Address - Phone:860-257-1699
Mailing Address - Fax:
Practice Address - Street 1:1229 ALBANY AVE
Practice Address - Street 2:
Practice Address - City:HARTFORD
Practice Address - State:CT
Practice Address - Zip Code:06112-2132
Practice Address - Country:US
Practice Address - Phone:860-728-0235
Practice Address - Fax:860-728-0234
Is Sole Proprietor?:No
Enumeration Date:2006-09-22
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT000569363LA2200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LA2200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAdult Health