Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207QA0505X | Family Doctor - Adult Medicine | M3283 | ID |
NPI | 1003866765 |
---|---|
Provider Name | Dr. Christina R Bjornstad |
First Address | Lewiston, ID 83501-9999 |
Second Address | Lewiston, ID 83501-9999 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 11/05/2006 |
Last Update Date | 16/04/2008 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
1083807 | (05) | WA |
B63233 | (02) | ID |