Healthcare Provider Details

I. General information

NPI: 1992133607
Provider Name (Legal Business Name): CHRISTINA MARIE BRAKEBILL RN, FNP-BC
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/16/2013
Last Update Date: 08/25/2026
Certification Date: 08/25/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1010 1ST ST SE STE 110
BANDON OR
97411-9301
US

IV. Provider business mailing address

PO BOX 1121
ROSEBURG OR
97470-0254
US

V. Phone/Fax

Practice location:
  • Phone: 541-347-2539
  • Fax: 541-347-9196
Mailing address:
  • Phone: 541-347-2529
  • Fax: 541-347-9196

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number314495
License Number StateGA
# 2
Primary TaxonomyN
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number209.010748
License Number StateIL
# 3
Primary TaxonomyN
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number10006133
License Number StateOR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: