Provider Demographics
NPI:1124457254
Name:MULINGBAYAN, KRISTINE (NP-C)
Entity type:Individual
Prefix:MRS
First Name:KRISTINE
Middle Name:
Last Name:MULINGBAYAN
Suffix:
Gender:F
Credentials:NP-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4711 GOLF RD
Mailing Address - Street 2:SUITE 807
Mailing Address - City:SKOKIE
Mailing Address - State:IL
Mailing Address - Zip Code:60076-1224
Mailing Address - Country:US
Mailing Address - Phone:847-677-7502
Mailing Address - Fax:847-677-7516
Practice Address - Street 1:4711 GOLF RD
Practice Address - Street 2:SUITE 807
Practice Address - City:SKOKIE
Practice Address - State:IL
Practice Address - Zip Code:60076-1224
Practice Address - Country:US
Practice Address - Phone:847-677-7502
Practice Address - Fax:847-677-7516
Is Sole Proprietor?:Yes
Enumeration Date:2013-11-08
Last Update Date:2014-06-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL209.010878363LA2200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LA2200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAdult Health