Provider Demographics
NPI:1700479623
Name:FIFAREK, CHRISTINE (LPN)
Entity Type:Individual
Prefix:
First Name:CHRISTINE
Middle Name:
Last Name:FIFAREK
Suffix:
Gender:F
Credentials:LPN
Other - Prefix:
Other - First Name:CHRISTINE
Other - Middle Name:
Other - Last Name:BOURQUIN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:5115 GLEN RD
Mailing Address - Street 2:
Mailing Address - City:MCFARLAND
Mailing Address - State:WI
Mailing Address - Zip Code:53558-9469
Mailing Address - Country:US
Mailing Address - Phone:443-754-1963
Mailing Address - Fax:
Practice Address - Street 1:5115 GLEN RD
Practice Address - Street 2:
Practice Address - City:MCFARLAND
Practice Address - State:WI
Practice Address - Zip Code:53558-9469
Practice Address - Country:US
Practice Address - Phone:443-754-1963
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-02-12
Last Update Date:2021-02-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI325636-31164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse