Basic Information
| Provider Information | |||||||||
| NPI: | 1104155167 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | CHRISTENSON | ||||||||
| FirstName: | NICOLE | ||||||||
| MiddleName: | RENEE | ||||||||
| NamePrefix: | MRS. | ||||||||
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| Credential: | CRNP-FAMILY | ||||||||
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| Mailing Information | |||||||||
| Address1: | 5730 EXECUTIVE DR STE 230 | ||||||||
| Address2: | |||||||||
| City: | CATONSVILLE | ||||||||
| State: | MD | ||||||||
| PostalCode: | 212281762 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4104022379 | ||||||||
| FaxNumber: | 4104693085 | ||||||||
| Practice Location | |||||||||
| Address1: | 3110 GRACEFIELD RD | ||||||||
| Address2: | |||||||||
| City: | SILVER SPRING | ||||||||
| State: | MD | ||||||||
| PostalCode: | 209041820 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3015728340 | ||||||||
| FaxNumber: | 3015738403 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 12/21/2009 | ||||||||
| LastUpdateDate: | 03/10/2022 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | 08/19/2020 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 363LF0000X | R120698 | MD | Y | Physician Assistants & Advanced Practice Nursing Providers | Nurse Practitioner | Family |
ID Information
| ID | Type | State | Issuer | Description | 799074000 | 05 | MD | MEDICAID |