Provider Demographics
NPI:1558806901
Name:CHRISTINE BAILES, LLC
Entity Type:Organization
Organization Name:CHRISTINE BAILES, LLC
Other - Org Name:PINNACLE NEUROLOGY & INFUSION
Other - Org Type:Doing Business As
Authorized Official - Title/Position:ANP / OWNER
Authorized Official - Prefix:
Authorized Official - First Name:CHRISTINE
Authorized Official - Middle Name:OLGA
Authorized Official - Last Name:BAILES
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:907-864-0022
Mailing Address - Street 1:3505 E MERIDIAN PARK LOOP STE 100
Mailing Address - Street 2:
Mailing Address - City:WASILLA
Mailing Address - State:AK
Mailing Address - Zip Code:99654-7242
Mailing Address - Country:US
Mailing Address - Phone:907-864-0022
Mailing Address - Fax:877-725-7371
Practice Address - Street 1:3505 E MERIDIAN PARK LOOP STE 100
Practice Address - Street 2:
Practice Address - City:WASILLA
Practice Address - State:AK
Practice Address - Zip Code:99654-7242
Practice Address - Country:US
Practice Address - Phone:907-864-0022
Practice Address - Fax:877-725-7371
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-12-21
Last Update Date:2023-09-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamilyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
AK1660501Medicaid
AK1630807Medicaid