Provider Demographics
NPI:1063726057
Name:CHRISTENSEN, WAYNE LEE
Entity type:Individual
Prefix:
First Name:WAYNE
Middle Name:LEE
Last Name:CHRISTENSEN
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:TAYLOR
Other - Middle Name:MARKETING
Other - Last Name:SERVICES
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:
Mailing Address - Street 1:6380 TUPELO DRIVE
Mailing Address - Street 2:STE #4
Mailing Address - City:CIRTRUS HEIGHTS
Mailing Address - State:CA
Mailing Address - Zip Code:95621-1778
Mailing Address - Country:US
Mailing Address - Phone:916-721-7518
Mailing Address - Fax:916-721-4529
Practice Address - Street 1:6380 TUPELO DRIVE
Practice Address - Street 2:STE #4
Practice Address - City:CIRTRUS HEIGHTS
Practice Address - State:CA
Practice Address - Zip Code:95621-1778
Practice Address - Country:US
Practice Address - Phone:916-721-7518
Practice Address - Fax:916-721-4529
Is Sole Proprietor?:Yes
Enumeration Date:2010-08-02
Last Update Date:2011-01-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies