Basic Information
| Provider Information | |||||||||
| NPI: | 1558475889 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | CHRISTENSEN | ||||||||
| FirstName: | DONNAN | ||||||||
| MiddleName: | LEIGH | ||||||||
| NamePrefix: | DR. | ||||||||
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| Credential: | M.D. | ||||||||
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| Mailing Information | |||||||||
| Address1: | 812 BRATLEY DR | ||||||||
| Address2: | |||||||||
| City: | WASHBURN | ||||||||
| State: | WI | ||||||||
| PostalCode: | 548914512 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7153735013 | ||||||||
| FaxNumber: | |||||||||
| Practice Location | |||||||||
| Address1: | 11040 N STATE ROAD 77 | ||||||||
| Address2: | HAYWARD AREA MEMORIAL HOSPITAL | ||||||||
| City: | HAYWARD | ||||||||
| State: | WI | ||||||||
| PostalCode: | 548436391 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7159344321 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 08/17/2006 | ||||||||
| LastUpdateDate: | 07/08/2007 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | Y | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207P00000X | 23405-020 | WI | Y | Allopathic & Osteopathic Physicians | Emergency Medicine |
ID Information
| ID | Type | State | Issuer | Description | 30359300 | 05 | WI | MEDICAID | AC9512674 | 01 | DEA NUMBER | OTHER |