Basic Information
| Provider Information | |||||||||
| NPI: | 1134643182 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | CHRISTENSEN | ||||||||
| FirstName: | ANNA | ||||||||
| MiddleName: | KATHRYN | ||||||||
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| Credential: | PA-C, MPH | ||||||||
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| Mailing Information | |||||||||
| Address1: | 100 MAIN ST APT 200 | ||||||||
| Address2: | |||||||||
| City: | VISTA | ||||||||
| State: | CA | ||||||||
| PostalCode: | 920846036 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5739990434 | ||||||||
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| Practice Location | |||||||||
| Address1: | 6644 E BAYWOOD AVE | ||||||||
| Address2: | |||||||||
| City: | MESA | ||||||||
| State: | AZ | ||||||||
| PostalCode: | 852061747 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4803212000 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 08/01/2017 | ||||||||
| LastUpdateDate: | 01/21/2022 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | 01/21/2022 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 363A00000X | 8870 | AZ | Y | Physician Assistants & Advanced Practice Nursing Providers | Physician Assistant | 363A00000X | 54701 | CA | N | Physician Assistants & Advanced Practice Nursing Providers | Physician Assistant |
No ID Information.