Provider Demographics
NPI:1700876596
Name:CHRISTENSEN, CARISSA LYNN
Entity Type:Individual
Prefix:MRS
First Name:CARISSA
Middle Name:LYNN
Last Name:CHRISTENSEN
Suffix:
Gender:F
Credentials:
Other - Prefix:MISS
Other - First Name:CARISSA
Other - Middle Name:LYNN
Other - Last Name:REEDER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:1050 JABARA AVE
Mailing Address - Street 2:SEYMOUR JOHNSON AFB
Mailing Address - City:GOLDSBORO
Mailing Address - State:NC
Mailing Address - Zip Code:27531-2310
Mailing Address - Country:US
Mailing Address - Phone:919-722-0928
Mailing Address - Fax:919-722-1952
Practice Address - Street 1:1050 JABARA AVE
Practice Address - Street 2:SEYMOUR JOHNSON AFB
Practice Address - City:GOLDSBORO
Practice Address - State:NC
Practice Address - Zip Code:27531-2310
Practice Address - Country:US
Practice Address - Phone:919-722-0928
Practice Address - Fax:919-722-1952
Is Sole Proprietor?:Not Answered
Enumeration Date:2005-10-24
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered