Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 2086S0102X | Surgical Critical Care | 25MA04723300 | NJ |
Y | 2086S0127X | Trauma Surgeon | 25MA04723300 | NJ |
NPI | 1063408722 |
---|---|
Provider Name | Dr. Loretta L Christensen |
First Address | Gallup, NM 87305-1337 |
Second Address | Gallup, NM 87301-1337 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 27/09/2005 |
Last Update Date | 13/12/2013 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
D18420 | (02) | NJ |