Provider Demographics
NPI:1336274018
Name:CHRISTENSEN, COURTNEY LYNN (RDH)
Entity Type:Individual
Prefix:MRS
First Name:COURTNEY
Middle Name:LYNN
Last Name:CHRISTENSEN
Suffix:
Gender:F
Credentials:RDH
Other - Prefix:MISS
Other - First Name:COURTNEY
Other - Middle Name:LYNN
Other - Last Name:WEIGELT
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:RDH
Mailing Address - Street 1:531 SECOND ST
Mailing Address - Street 2:
Mailing Address - City:OCONTO
Mailing Address - State:WI
Mailing Address - Zip Code:54153
Mailing Address - Country:US
Mailing Address - Phone:920-835-0122
Mailing Address - Fax:
Practice Address - Street 1:1711 SHAWANO AVE
Practice Address - Street 2:
Practice Address - City:GREEN BAY
Practice Address - State:WI
Practice Address - Zip Code:54303
Practice Address - Country:US
Practice Address - Phone:920-494-9541
Practice Address - Fax:920-494-8195
Is Sole Proprietor?:No
Enumeration Date:2007-02-22
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI5932016124Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes124Q00000XDental ProvidersDental Hygienist