Provider Demographics
NPI:1881557288
Name:CHRISTMAS, NINA ETIENNE
Entity type:Individual
Prefix:MS
First Name:NINA
Middle Name:ETIENNE
Last Name:CHRISTMAS
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9520 MAYFIELD AVE APT N302
Mailing Address - Street 2:
Mailing Address - City:OAK LAWN
Mailing Address - State:IL
Mailing Address - Zip Code:60453-0002
Mailing Address - Country:US
Mailing Address - Phone:872-262-6555
Mailing Address - Fax:
Practice Address - Street 1:606 W ROOSEVELT RD
Practice Address - Street 2:
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60607-4912
Practice Address - Country:US
Practice Address - Phone:872-262-6555
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2025-12-03
Last Update Date:2025-12-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
174400000X, 171400000X, 171W00000X
IL012.007649174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist
No171400000XOther Service ProvidersHealth & Wellness Coach
No171W00000XOther Service ProvidersContractor