Healthcare Provider Details

I. General information

NPI: 1477975241
Provider Name (Legal Business Name): CHRISTINA WAKEM R.N. , IBCLC
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 01/14/2014
Last Update Date: 01/14/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

43586 SPORTS LAKE RD
SOLDOTNA AK
99669-6819
US

IV. Provider business mailing address

43586 SPORTS LAKE RD
SOLDOTNA AK
99669-6819
US

V. Phone/Fax

Practice location:
  • Phone: 907-947-0832
  • Fax:
Mailing address:
  • Phone: 907-947-0832
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163WL0100X
TaxonomyLactation Consultant (Registered Nurse)
License Number19861
License Number StateAK
# 2
Primary TaxonomyN
Taxonomy Code163WM0102X
TaxonomyMaternal Newborn Registered Nurse
License Number19861
License Number StateAK

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: