Provider Demographics
NPI:1730265752
Name:CHRISTENSON, NICOLE ANN (MD)
Entity type:Individual
Prefix:DR
First Name:NICOLE
Middle Name:ANN
Last Name:CHRISTENSON
Suffix:
Gender:F
Credentials:MD
Other - Prefix:MRS
Other - First Name:NICOLE
Other - Middle Name:ANN
Other - Last Name:CHRISTENSON-KEISACKER
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:MD
Mailing Address - Street 1:PO BOX 86370
Mailing Address - Street 2:
Mailing Address - City:SIOUX FALLS
Mailing Address - State:SD
Mailing Address - Zip Code:57118-6370
Mailing Address - Country:US
Mailing Address - Phone:605-322-7510
Mailing Address - Fax:
Practice Address - Street 1:4400 W 69TH ST
Practice Address - Street 2:STE 1500
Practice Address - City:SIOUX FALLS
Practice Address - State:SD
Practice Address - Zip Code:57108-8170
Practice Address - Country:US
Practice Address - Phone:605-322-5735
Practice Address - Fax:605-322-5736
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-31
Last Update Date:2018-10-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SD70122084P0804X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0804XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyChild & Adolescent Psychiatry
Provider Identifiers
StateIdentifier IDID TypeIssuer
255968OtherMIDLAND'S CHOICE
SDSD7012OtherSOUTH DAKOTA LICENSE
SD7101990Medicaid
SD7012OtherDAKOTACARE
SD7101990Medicaid
SD102505Medicare PIN