Provider Demographics
NPI:1609215755
Name:CHRISTENSEN, DUSTIN (DPM)
Entity type:Individual
Prefix:
First Name:DUSTIN
Middle Name:
Last Name:CHRISTENSEN
Suffix:
Gender:M
Credentials:DPM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:815 S MAPLE ST
Mailing Address - Street 2:
Mailing Address - City:NORTH PLATTE
Mailing Address - State:NE
Mailing Address - Zip Code:69101-5282
Mailing Address - Country:US
Mailing Address - Phone:308-532-3600
Mailing Address - Fax:308-532-6288
Practice Address - Street 1:815 S MAPLE ST
Practice Address - Street 2:
Practice Address - City:NORTH PLATTE
Practice Address - State:NE
Practice Address - Zip Code:69101-5282
Practice Address - Country:US
Practice Address - Phone:308-532-3600
Practice Address - Fax:308-532-6288
Is Sole Proprietor?:No
Enumeration Date:2013-06-21
Last Update Date:2019-01-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KS12-00417213E00000X
NE375213E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes213E00000XPodiatric Medicine & Surgery Service ProvidersPodiatrist