Healthcare Provider Details

I. General information

NPI: 1003627837
Provider Name (Legal Business Name): CHRISTINE MICHELE PERAK RN BSN/IBCLC
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/20/2025
Last Update Date: 01/20/2025
Certification Date: 01/20/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

777 BANNOCK ST
DENVER CO
80204-4597
US

IV. Provider business mailing address

4275 E 6TH AVENUE PKWY
DENVER CO
80220-4908
US

V. Phone/Fax

Practice location:
  • Phone: 303-602-9290
  • Fax:
Mailing address:
  • Phone: 620-255-4225
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163WL0100X
TaxonomyLactation Consultant (Registered Nurse)
License Number1636901
License Number StateCO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: