Provider Demographics
NPI:1780674770
Name:CHRISTENSEN, PAUL H (NP)
Entity type:Individual
Prefix:
First Name:PAUL
Middle Name:H
Last Name:CHRISTENSEN
Suffix:
Gender:M
Credentials:NP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:217 W GEORGIA AVE
Mailing Address - Street 2:SUITE 115
Mailing Address - City:NAMPA
Mailing Address - State:ID
Mailing Address - Zip Code:83686-6811
Mailing Address - Country:US
Mailing Address - Phone:208-463-3234
Mailing Address - Fax:208-463-3044
Practice Address - Street 1:215& E HAWAII AVE
Practice Address - Street 2:
Practice Address - City:NAMPA
Practice Address - State:ID
Practice Address - Zip Code:83686-6011
Practice Address - Country:US
Practice Address - Phone:208-463-3234
Practice Address - Fax:208-463-3044
Is Sole Proprietor?:No
Enumeration Date:2005-10-21
Last Update Date:2009-12-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IDNP483A363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
Provider Identifiers
StateIdentifier IDID TypeIssuer
IDPA860OtherBLUE CROSS
ID970019572OtherRAILROAD MEDICARE
ID000010017487OtherBLUE SHIELD
ID000010017488OtherBLUE SHIELD
ID805233800Medicaid
IDPA811OtherBLUE CROSS
ID1343155Medicare ID - Type Unspecified
IDPA860OtherBLUE CROSS