Provider Demographics
NPI:1053393967
Name:DAY, CHRISTINE M (RN,MS,APRN,BC)
Entity type:Individual
Prefix:
First Name:CHRISTINE
Middle Name:M
Last Name:DAY
Suffix:
Gender:F
Credentials:RN,MS,APRN,BC
Other - Prefix:
Other - First Name:CHRISTINE
Other - Middle Name:M
Other - Last Name:STEPHENSON
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:RN
Mailing Address - Street 1:1502 LONDON RD
Mailing Address - Street 2:SUITE 102
Mailing Address - City:DULUTH
Mailing Address - State:MN
Mailing Address - Zip Code:55812-1788
Mailing Address - Country:US
Mailing Address - Phone:218-727-8228
Mailing Address - Fax:
Practice Address - Street 1:1502 LONDON RD
Practice Address - Street 2:SUITE 102
Practice Address - City:DULUTH
Practice Address - State:MN
Practice Address - Zip Code:55812-1788
Practice Address - Country:US
Practice Address - Phone:218-727-8228
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2005-11-16
Last Update Date:2011-12-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MNR75327-6364SA2200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes364SA2200XPhysician Assistants & Advanced Practice Nursing ProvidersClinical Nurse SpecialistAdult Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
MN477458200Medicaid
WI1053393967Medicaid
WI1053393967Medicaid