1356703532 NPI number — SHAYLA DANAE CHRISTENSEN

Table of content: SHAYLA DANAE CHRISTENSEN (NPI 1356703532)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1356703532 NPI number — SHAYLA DANAE CHRISTENSEN

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
CHRISTENSEN
Provider First Name:
SHAYLA
Provider Middle Name:
DANAE
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1356703532
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
03/25/2016
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
1809 PAINTBRUSH DR
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
SHERIDAN
Provider Business Mailing Address State Name:
WY
Provider Business Mailing Address Postal Code:
82801-6726
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
307-763-0997
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
500 UNIVERSITY AVE W
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
MINOT
Provider Business Practice Location Address State Name:
ND
Provider Business Practice Location Address Postal Code:
58707-0001
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
701-858-3028
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
03/25/2016

Additional Information

			
		

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 2255A2300X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)