Provider Demographics
NPI:1790674778
Name:CHRISTENSEN, MIRANDA R (PSS, CRM,)
Entity type:Individual
Prefix:
First Name:MIRANDA
Middle Name:R
Last Name:CHRISTENSEN
Suffix:
Gender:F
Credentials:PSS, CRM,
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2601 NE JACK LONDON ST UNIT 138
Mailing Address - Street 2:
Mailing Address - City:CORVALLIS
Mailing Address - State:OR
Mailing Address - Zip Code:97330-6906
Mailing Address - Country:US
Mailing Address - Phone:541-745-9518
Mailing Address - Fax:
Practice Address - Street 1:680 TYLER ST
Practice Address - Street 2:
Practice Address - City:EUGENE
Practice Address - State:OR
Practice Address - Zip Code:97402-4530
Practice Address - Country:US
Practice Address - Phone:541-603-0276
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2025-07-02
Last Update Date:2025-07-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR175T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes175T00000XOther Service ProvidersPeer Specialist