1386654333 NPI number — DR. HOLLI J CHRISTENSEN AUD

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1386654333 NPI number — DR. HOLLI J CHRISTENSEN AUD

Employer Identification Number (EIN):

Provider Organization Name:

Provider Last Name:

CHRISTENSEN

Provider First Name:

HOLLI

Provider Middle Name:

J

Provider Name Prefix Text:

DR.

Provider Name Suffix Text:

Provider Credential Text:

AUD

Provider Gender Code:

F

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:

1386654333

Entity Type Code:

Individual

Replacement NPI:

Last Update Date:

10/24/2017

NPI Deactivation Reason Code:

NPI Deactivation Date:

NPI Reactivation Date:

Provider First Line Business Mailing Address:

340 VISTA AVE SE STE 100

Provider Second Line Business Mailing Address:

Provider Business Mailing Address City Name:

SALEM

Provider Business Mailing Address State Name:

OR

Provider Business Mailing Address Postal Code:

97302-4546

Provider Business Mailing Address Country Code:

US

Provider Business Mailing Address Telephone Number:

503-877-9966

Provider Business Mailing Address Fax Number:

Provider First Line Business Practice Location Address:

340 VISTA AVE SE STE 100

Provider Second Line Business Practice Location Address:

Provider Business Practice Location Address City Name:

SALEM

Provider Business Practice Location Address State Name:

OR

Provider Business Practice Location Address Postal Code:

97302-4546

Provider Business Practice Location Address Country Code:

US

Provider Business Practice Location Address Telephone Number:

503-877-9966

Provider Business Practice Location Address Fax Number:

Provider Enumeration Date:

08/09/2006

Authorized Official Last Name:

Authorized Official First Name:

Authorized Official Middle Name:

Authorized Official Title or Position:

Authorized Official Telephone Number:

• Taxonomy code: 231H00000X , with the licence number:  1016 , registered in the state of WA ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
• Taxonomy code: 231H00000X , with the licence number: 030892 , registered in the state of OR ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

• Identifier: 180216 . This is a "LABOR & INDUSTRIES" identifier . This identifiers is of the category "OTHER".
• Identifier: P00125317 . This is a "RAILROAD MEDICARE" identifier . This identifiers is of the category "OTHER".
• Identifier: 8931874 . This is a "CRIME VICTIMS" identifier . This identifiers is of the category "OTHER".
• Identifier: 1019672 . This is a "CHPW" identifier . This identifiers is of the category "OTHER".
• Identifier: 770619165 . This is a "UNIFORM MEDICAL PLAN" identifier . This identifiers is of the category "OTHER".
• Identifier: 770619165 . This is a "MOLINA HEALTHCARE OF WA" identifier . This identifiers is of the category "OTHER".
• Identifier: 770619165 . This is a "PREMERA BLUE CROSS" identifier . This identifiers is of the category "OTHER".
• Identifier: A003 . This is a "TRI-CARE" identifier . This identifiers is of the category "OTHER".
• Identifier: 770619165 . This is a "FIRST CHOICE PPO" identifier . This identifiers is of the category "OTHER".
• Identifier: 770619165 . This is a "UNITED HEALTH NETWORK" identifier . This identifiers is of the category "OTHER".
• Identifier: 8381816 . This is a "DSHS" identifier . This identifiers is of the category "OTHER".
• Identifier: 9165CH . This is a "REGENCE BLUE SHIELD" identifier . This identifiers is of the category "OTHER".