Provider Demographics
NPI:1548072374
Name:CHRISTENSEN, CARLY J
Entity type:Individual
Prefix:
First Name:CARLY
Middle Name:J
Last Name:CHRISTENSEN
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 1:217 4TH ST SW APT A
Mailing Address - Street 2:
Mailing Address - City:ORANGE CITY
Mailing Address - State:IA
Mailing Address - Zip Code:51041-1617
Mailing Address - Country:US
Mailing Address - Phone:952-567-9654
Mailing Address - Fax:
Practice Address - Street 1:217 4TH ST SW APT A
Practice Address - Street 2:
Practice Address - City:ORANGE CITY
Practice Address - State:IA
Practice Address - Zip Code:51041-1617
Practice Address - Country:US
Practice Address - Phone:952-567-9654
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2025-01-20
Last Update Date:2025-02-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant