Individual
MARY J CHRISTENSEN
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
M.S.N., A.P.N.
Contact information
Practice address
885 ROOSEVELT RD, GLEN ELLYN, IL 60137-6141
(630) 790-1555
(630) 545-3787
Mailing address
885 ROOSEVELT RD, GLEN ELLYN, IL 60137-6141
(630) 790-1555
(630) 545-3787
Taxonomy
Speciality
Code
Description
License number
State
363L00000X
Nurse Practitioner
Primary
209005290
IL
363LP2300X
Primary Care Nurse Practitioner
209.005290
IL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
920540
MEDICARE PTAN (GROUP)
IL
01
—
920540030
MEDICARE PTAN (INDIVIDUAL)
IL
Enumeration date
01/16/2007
Last updated
04/02/2013
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