Basic Information
| Provider Information | |||||||||
| NPI: | 1841308681 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | CHRISTENSEN | ||||||||
| FirstName: | RITA | ||||||||
| MiddleName: | ANN | ||||||||
| NamePrefix: | MS. | ||||||||
| NameSuffix: | |||||||||
| Credential: | APNP | ||||||||
| OtherOrganizationName: | |||||||||
| OtherOrganizationType: | |||||||||
| OtherLastName: | PAIDER | ||||||||
| OtherFirstName: | RITA | ||||||||
| OtherMiddleName: | A | ||||||||
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| OtherNameSuffix: | |||||||||
| OtherCredential: | |||||||||
| OtherLastNameType: | 1 | ||||||||
| Mailing Information | |||||||||
| Address1: | 4131 W. LOOMIS RD. | ||||||||
| Address2: | STE 300 | ||||||||
| City: | GREENFIELD | ||||||||
| State: | WI | ||||||||
| PostalCode: | 532212059 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4143257246 | ||||||||
| FaxNumber: | 4143253770 | ||||||||
| Practice Location | |||||||||
| Address1: | 4131 W. LOOMIS RD. | ||||||||
| Address2: | STE 300 | ||||||||
| City: | GREENFIELD | ||||||||
| State: | WI | ||||||||
| PostalCode: | 532212059 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4143257246 | ||||||||
| FaxNumber: | 4143253770 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 08/29/2006 | ||||||||
| LastUpdateDate: | 02/24/2014 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| AuthorizedOfficialMiddleName: | |||||||||
| AuthorizedOfficialTitleorPosition: | |||||||||
| AuthorizedOfficialTelephone: | |||||||||
| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | |||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 363L00000X | 2326 033 | WI | Y | Physician Assistants & Advanced Practice Nursing Providers | Nurse Practitioner |
ID Information
| ID | Type | State | Issuer | Description | MC1016030 | 01 | WI | DEA | OTHER | 41175500 | 05 | WI | MEDICAID |