Provider Demographics
NPI:1437042652
Name:CHRISTENSEN, REILLY SHAW (LPN)
Entity type:Individual
Prefix:
First Name:REILLY
Middle Name:SHAW
Last Name:CHRISTENSEN
Suffix:
Gender:F
Credentials:LPN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:11081 COUNTY ROAD 5 E
Mailing Address - Street 2:
Mailing Address - City:CENTER
Mailing Address - State:CO
Mailing Address - Zip Code:81125-9654
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:2265 LAVA LN
Practice Address - Street 2:
Practice Address - City:ALAMOSA
Practice Address - State:CO
Practice Address - Zip Code:81101-3578
Practice Address - Country:US
Practice Address - Phone:719-589-5176
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2025-05-29
Last Update Date:2025-05-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
COPN.0338641164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse