Provider Demographics
NPI:1811778962
Name:CHRISTENSEN, MAUREEN MARIE TRACY (RN)
Entity type:Individual
Prefix:
First Name:MAUREEN
Middle Name:MARIE TRACY
Last Name:CHRISTENSEN
Suffix:
Gender:F
Credentials:RN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:782 BROADWAY
Mailing Address - Street 2:
Mailing Address - City:DAVISBURG
Mailing Address - State:MI
Mailing Address - Zip Code:48350-2402
Mailing Address - Country:US
Mailing Address - Phone:313-410-3734
Mailing Address - Fax:
Practice Address - Street 1:782 BROADWAY
Practice Address - Street 2:
Practice Address - City:DAVISBURG
Practice Address - State:MI
Practice Address - Zip Code:48350-2402
Practice Address - Country:US
Practice Address - Phone:313-410-3734
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-10-12
Last Update Date:2023-10-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI4704240923163WW0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes163WW0000XNursing Service ProvidersRegistered NurseWound CareGroup - Single Specialty