Provider Demographics
NPI:1477975241
Name:WAKEM, CHRISTINA (RN , IBCLC)
Entity Type:Individual
Prefix:
First Name:CHRISTINA
Middle Name:
Last Name:WAKEM
Suffix:
Gender:F
Credentials:RN , IBCLC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:43586 SPORTS LAKE RD
Mailing Address - Street 2:
Mailing Address - City:SOLDOTNA
Mailing Address - State:AK
Mailing Address - Zip Code:99669-6819
Mailing Address - Country:US
Mailing Address - Phone:907-947-0832
Mailing Address - Fax:
Practice Address - Street 1:43586 SPORTS LAKE RD
Practice Address - Street 2:
Practice Address - City:SOLDOTNA
Practice Address - State:AK
Practice Address - Zip Code:99669-6819
Practice Address - Country:US
Practice Address - Phone:907-947-0832
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2014-01-14
Last Update Date:2014-01-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AK19861163WL0100X, 163WM0102X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WL0100XNursing Service ProvidersRegistered NurseLactation Consultant
No163WM0102XNursing Service ProvidersRegistered NurseMaternal Newborn