Basic Information
Provider Information
NPI: 1013276641
EntityType: 1
ReplacementNPI:  
OrganizationName:  
LastName: CHRISTENSEN
FirstName: ALISA-ANN
MiddleName:  
NamePrefix:  
NameSuffix:  
Credential: D.O.
OtherOrganizationName:  
OtherOrganizationType:  
OtherLastName: HYUN
OtherFirstName: ALISA-ANN
OtherMiddleName: HIILEI
OtherNamePrefix:  
OtherNameSuffix:  
OtherCredential:  
OtherLastNameType: 1
Mailing Information
Address1: PO BOX 635283
Address2:  
City: CINCINNATI
State: OH
PostalCode: 452635283
CountryCode: US
TelephoneNumber: 8594281610
FaxNumber: 8594283923
Practice Location
Address1: 520 VIOLET RD
Address2:  
City: CRITTENDEN
State: KY
PostalCode: 41030
CountryCode: US
TelephoneNumber: 8594281610
FaxNumber: 8594283923
Other Information
ProviderEnumerationDate: 05/16/2012
LastUpdateDate: 09/07/2018
NPIDeactivationReasonCode:  
NPIDeactivationDate:  
NPIReactivationDate:  
ProviderGenderCode: F
AuthorizedOfficialLastName:  
AuthorizedOfficialFirstName:  
AuthorizedOfficialMiddleName:  
AuthorizedOfficialTitleorPosition:  
AuthorizedOfficialTelephone:  
IsSoleProprietor: Y
IsOrganizationSubpart:  
ParentOrganizationLBN:  
AuthorizedOfficialNamePrefix:  
AuthorizedOfficialNameSuffix:  
AuthorizedOfficialCredential:  
NPICertificationDate:  

Taxonomy Information
TaxonomyLicenseStateSwitchTaxonomyGroupTaxonomyTypeTaxonomyClassSubSpecialty
207Q00000XTP583KYY Allopathic & Osteopathic PhysiciansFamily Medicine 
207Q00000X5101019772MIN Allopathic & Osteopathic PhysiciansFamily Medicine 

No ID Information.


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