Provider Demographics
NPI:1154201457
Name:ELIZAGA, CHRISTENSEN ANDAL
Entity type:Individual
Prefix:MISS
First Name:CHRISTENSEN
Middle Name:ANDAL
Last Name:ELIZAGA
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:187 BOSWELL RD
Mailing Address - Street 2:
Mailing Address - City:PHENIX CITY
Mailing Address - State:AL
Mailing Address - Zip Code:36869-3129
Mailing Address - Country:US
Mailing Address - Phone:706-315-3082
Mailing Address - Fax:
Practice Address - Street 1:187 BOSWELL RD
Practice Address - Street 2:
Practice Address - City:PHENIX CITY
Practice Address - State:AL
Practice Address - Zip Code:36869-3129
Practice Address - Country:US
Practice Address - Phone:706-315-3082
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2025-09-05
Last Update Date:2025-09-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GARN301451163WP0200X, 163WP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes163WP0808XNursing Service ProvidersRegistered NursePsychiatric/Mental HealthGroup - Multi-Specialty
No163WP0200XNursing Service ProvidersRegistered NursePediatricsGroup - Multi-Specialty