Provider Demographics
NPI:1841686201
Name:BAILES, CHRISTINE OLGA (RN, MSN, FNP)
Entity type:Individual
Prefix:
First Name:CHRISTINE
Middle Name:OLGA
Last Name:BAILES
Suffix:
Gender:F
Credentials:RN, MSN, FNP
Other - Prefix:
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Other - Middle Name:
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Mailing Address - Street 1:PO BOX 75589
Mailing Address - Street 2:
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60675-5589
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
Is Sole Proprietor?:No
Enumeration Date:2015-04-13
Last Update Date:2023-04-26
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
AK1536363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
AK1630807Medicaid
AK1660501Medicaid