Healthcare Provider Details

I. General information

NPI: 1881557288
Provider Name (Legal Business Name): MS. NINA ETIENNE CHRISTMAS
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 12/03/2025
Last Update Date: 12/03/2025
Certification Date: 12/03/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

606 W ROOSEVELT RD
CHICAGO IL
60607-4912
US

IV. Provider business mailing address

9520 MAYFIELD AVE APT N302
OAK LAWN IL
60453-0002
US

V. Phone/Fax

Practice location:
  • Phone: 872-262-6555
  • Fax:
Mailing address:
  • Phone: 872-262-6555
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code171W00000X
TaxonomyContractor
License Number
License Number StateNULL
# 2
Primary TaxonomyY
Taxonomy Code174400000X
TaxonomySpecialist
License Number
License Number StateNULL
# 3
Primary TaxonomyN
Taxonomy Code174400000X
TaxonomySpecialist
License Number012.007649
License Number StateIL
# 4
Primary TaxonomyN
Taxonomy Code171400000X
TaxonomyHealth & Wellness Coach
License Number
License Number StateNULL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: