Provider Demographics
NPI:1780601658
Name:CHRISTENSEN, ERIN KELLOGG (MD)
Entity type:Individual
Prefix:
First Name:ERIN
Middle Name:KELLOGG
Last Name:CHRISTENSEN
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9000 AIRLINE HWY
Mailing Address - Street 2:SUITE 500
Mailing Address - City:BATON ROUGE
Mailing Address - State:LA
Mailing Address - Zip Code:70815-4114
Mailing Address - Country:US
Mailing Address - Phone:225-201-2000
Mailing Address - Fax:225-201-2110
Practice Address - Street 1:9000 AIRLINE HWY
Practice Address - Street 2:SUITE 500
Practice Address - City:BATON ROUGE
Practice Address - State:LA
Practice Address - Zip Code:70815-4114
Practice Address - Country:US
Practice Address - Phone:225-201-2000
Practice Address - Fax:225-201-2110
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-16
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA200682207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & Gynecology
Provider Identifiers
StateIdentifier IDID TypeIssuer
MS18861OtherMS STATE MEDICAL LICENSE
LA200682OtherLA STATE MEDICAL LICENSE
LAI37566Medicare UPIN