Provider Demographics
NPI:1083487805
Name:CHRISTOPHER, CHANISE (PMHNP)
Entity type:Individual
Prefix:
First Name:CHANISE
Middle Name:
Last Name:CHRISTOPHER
Suffix:
Gender:F
Credentials:PMHNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3300 N TRIUMPH BLVD STE 500
Mailing Address - Street 2:
Mailing Address - City:LEHI
Mailing Address - State:UT
Mailing Address - Zip Code:84043-6475
Mailing Address - Country:US
Mailing Address - Phone:801-821-2781
Mailing Address - Fax:801-901-1194
Practice Address - Street 1:500 DISCOVERY PKWY STE 250
Practice Address - Street 2:
Practice Address - City:SUPERIOR
Practice Address - State:CO
Practice Address - Zip Code:80027-8762
Practice Address - Country:US
Practice Address - Phone:720-712-0306
Practice Address - Fax:720-302-1505
Is Sole Proprietor?:No
Enumeration Date:2023-11-02
Last Update Date:2025-08-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
COAPN.1000919363LP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health