Healthcare Provider Details

I. General information

NPI: 1639654304
Provider Name (Legal Business Name): CHRISTINE MARIE FANELLI APRN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/28/2018
Last Update Date: 12/12/2025
Certification Date: 12/12/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

230 E MARYDALE AVE
SOLDOTNA AK
99669-7648
US

IV. Provider business mailing address

PO BOX 2949
SOLDOTNA AK
99669-2949
US

V. Phone/Fax

Practice location:
  • Phone: 907-262-3119
  • Fax: 907-262-9290
Mailing address:
  • Phone: 907-395-4303
  • Fax: 907-262-9290

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number243290
License Number StateAK

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: