Provider Demographics
NPI:1336413939
Name:CHRISTENSEN, LANE BART (DNP)
Entity Type:Individual
Prefix:
First Name:LANE
Middle Name:BART
Last Name:CHRISTENSEN
Suffix:
Gender:M
Credentials:DNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3667 N 200 E
Mailing Address - Street 2:
Mailing Address - City:NORTH OGDEN
Mailing Address - State:UT
Mailing Address - Zip Code:84414-2626
Mailing Address - Country:US
Mailing Address - Phone:801-391-0408
Mailing Address - Fax:
Practice Address - Street 1:4650 HARRISON BLVD
Practice Address - Street 2:
Practice Address - City:OGDEN
Practice Address - State:UT
Practice Address - Zip Code:84403-4303
Practice Address - Country:US
Practice Address - Phone:801-475-3021
Practice Address - Fax:801-475-3031
Is Sole Proprietor?:No
Enumeration Date:2012-02-28
Last Update Date:2021-06-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT5911408-4405363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
Provider Identifiers
StateIdentifier IDID TypeIssuer
UTU000091543Medicare PIN
WARN60274266OtherRN LICENSE