Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207YX0007X | Plastic Surgeon (Head & Neck) | DO181810 | OR |
N | 207YX0007X | Plastic Surgeon (Head & Neck) | OS15571 | FL |
NPI | 1801156161 |
---|---|
Provider Name | Jennifer Ruth Christenson |
First Address | Coos Bay, OR 97420-2099 |
Second Address | Coos Bay, OR 97420-2099 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 21/05/2012 |
Last Update Date | 18/01/2021 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
500721760 | (05) | OR |