Individual
MRS. KELLI DEANNE CHRISTENSEN
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
MD
Contact information
Practice address
2850 OLYMPUS DR., POCATELLO, ID 83201
(208) 239-3815
(208) 239-3814
Mailing address
2850 OLYMPUS DR., POCATELLO, ID 83201
(208) 239-3815
(208) 239-3814
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
Primary
M9428
ID
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
1366443699
—
ID
05
—
8070707000
—
ID
Enumeration date
08/09/2005
Last updated
12/28/2023
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