Healthcare Provider Details

I. General information

NPI: 1467375881
Provider Name (Legal Business Name): CHRISTINA MALTBIA BSN, RN
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/03/2026
Last Update Date: 08/03/2026
Certification Date: 08/03/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6555 S VERNON AVE
CHICAGO IL
60637-3213
US

IV. Provider business mailing address

6555 S VERNON AVE
CHICAGO IL
60637-3213
US

V. Phone/Fax

Practice location:
  • Phone: 773-712-5742
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License Number041436103
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: