Basic Information
Provider Information
NPI: 1306288444
EntityType: 1
ReplacementNPI:  
OrganizationName:  
LastName: CHRISTENSEN
FirstName: DANIEL
MiddleName: SCOTT
NamePrefix:  
NameSuffix:  
Credential: APRN
OtherOrganizationName:  
OtherOrganizationType:  
OtherLastName:  
OtherFirstName:  
OtherMiddleName:  
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OtherNameSuffix:  
OtherCredential:  
OtherLastNameType:  
Mailing Information
Address1: 7909 FREDERICKSBURG RD STE 110
Address2:  
City: SAN ANTONIO
State: TX
PostalCode: 782293400
CountryCode: US
TelephoneNumber: 2106144544
FaxNumber: 2106793724
Practice Location
Address1: 7909 FREDERICKSBURG RD STE 227
Address2:  
City: SAN ANTONIO
State: TX
PostalCode: 782293403
CountryCode: US
TelephoneNumber: 2106144544
FaxNumber: 2106793719
Other Information
ProviderEnumerationDate: 07/17/2013
LastUpdateDate: 10/08/2018
NPIDeactivationReasonCode:  
NPIDeactivationDate:  
NPIReactivationDate:  
ProviderGenderCode: M
AuthorizedOfficialLastName:  
AuthorizedOfficialFirstName:  
AuthorizedOfficialMiddleName:  
AuthorizedOfficialTitleorPosition:  
AuthorizedOfficialTelephone:  
IsSoleProprietor: N
IsOrganizationSubpart:  
ParentOrganizationLBN:  
AuthorizedOfficialNamePrefix:  
AuthorizedOfficialNameSuffix:  
AuthorizedOfficialCredential:  
NPICertificationDate:  

Taxonomy Information
TaxonomyLicenseStateSwitchTaxonomyGroupTaxonomyTypeTaxonomyClassSubSpecialty
363LA2100XAP124049TXY Physician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAcute Care
363L00000X690658TXN Physician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner 

No ID Information.


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