Basic Information
Provider Information
NPI: 1053650333
EntityType: 1
ReplacementNPI:  
OrganizationName:  
LastName: CHRISTENSEN
FirstName: ANNE
MiddleName: MARIE
NamePrefix: MISS
NameSuffix:  
Credential: LMP
OtherOrganizationName:  
OtherOrganizationType:  
OtherLastName:  
OtherFirstName:  
OtherMiddleName:  
OtherNamePrefix:  
OtherNameSuffix:  
OtherCredential:  
OtherLastNameType:  
Mailing Information
Address1: 22720 SE 16TH ST
Address2:  
City: SAMMAMISH
State: WA
PostalCode: 980759505
CountryCode: US
TelephoneNumber: 4255571049
FaxNumber:  
Practice Location
Address1: 670 NW GILMAN BLVD
Address2: SUITE B2
City: ISSAQUAH
State: WA
PostalCode: 980272444
CountryCode: US
TelephoneNumber: 4254276562
FaxNumber: 4253912760
Other Information
ProviderEnumerationDate: 02/07/2013
LastUpdateDate: 02/07/2013
NPIDeactivationReasonCode:  
NPIDeactivationDate:  
NPIReactivationDate:  
ProviderGenderCode: F
AuthorizedOfficialLastName:  
AuthorizedOfficialFirstName:  
AuthorizedOfficialMiddleName:  
AuthorizedOfficialTitleorPosition:  
AuthorizedOfficialTelephone:  
IsSoleProprietor: N
IsOrganizationSubpart:  
ParentOrganizationLBN:  
AuthorizedOfficialNamePrefix:  
AuthorizedOfficialNameSuffix:  
AuthorizedOfficialCredential:  
NPICertificationDate:  

Taxonomy Information
TaxonomyLicenseStateSwitchTaxonomyGroupTaxonomyTypeTaxonomyClassSubSpecialty
225700000X60303793WAY Respiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist 

No ID Information.


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