Healthcare Provider Details

I. General information

NPI: 1316930001
Provider Name (Legal Business Name): CRISTIN MARIA RASSI APN CNS
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: MISS CRISTIN MARIA BAKER

II. Dates (important events)

Enumeration Date: 08/26/2005
Last Update Date: 10/21/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

200 E PENNSYLVANIA AVE
PEORIA IL
61603-3089
US

IV. Provider business mailing address

200 E PENNSYLVANIA AVE
PEORIA IL
61603-3089
US

V. Phone/Fax

Practice location:
  • Phone: 309-624-4000
  • Fax: 309-624-4010
Mailing address:
  • Phone: 309-624-4000
  • Fax: 309-624-4010

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code364S00000X
TaxonomyClinical Nurse Specialist
License Number277000209
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: