Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207KA0200X | Allergist | 6171 | NV |
NPI | 1700830015 |
---|---|
Provider Name | Dr. Jim Christensen |
First Address | Las Vegas, NV 89133-5380 |
Second Address | Las Vegas, NV 89102-1535 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 20/05/2006 |
Last Update Date | 26/09/2017 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
002019068 | (05) | NV |
E41200 | (02) | NV |