Healthcare Provider Details

I. General information

NPI: 1588354260
Provider Name (Legal Business Name): CHRISTINA A BAJOREK PHD, RN
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/08/2023
Last Update Date: 05/08/2023
Certification Date: 05/08/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3528 S 87TH ST
MILWAUKEE WI
53228-1514
US

IV. Provider business mailing address

3528 S 87TH ST
MILWAUKEE WI
53228-1514
US

V. Phone/Fax

Practice location:
  • Phone: 414-975-6660
  • Fax:
Mailing address:
  • Phone: 414-975-6660
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163WP0808X
TaxonomyPsychiatric/Mental Health Registered Nurse
License Number166700-30
License Number StateWI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: