Provider Demographics
NPI:1366902116
Name:CHRISTOPHERSON, TAMARA JEAN
Entity type:Individual
Prefix:MRS
First Name:TAMARA
Middle Name:JEAN
Last Name:CHRISTOPHERSON
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1000 SOUTH BENTON DRIVE SUITE 415
Mailing Address - Street 2:
Mailing Address - City:SAUK RAPIDS
Mailing Address - State:MN
Mailing Address - Zip Code:56379
Mailing Address - Country:US
Mailing Address - Phone:320-281-5110
Mailing Address - Fax:
Practice Address - Street 1:1000 SOUTH BENTON DRIVE SUITE 415
Practice Address - Street 2:
Practice Address - City:SAUK RAPIDS
Practice Address - State:MN
Practice Address - Zip Code:56379
Practice Address - Country:US
Practice Address - Phone:320-281-5110
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-03-20
Last Update Date:2019-03-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist