Provider Demographics
NPI:1992911341
Name:REPKA, CHRISTINA HELEN (RSA)
Entity type:Individual
Prefix:MS
First Name:CHRISTINA
Middle Name:HELEN
Last Name:REPKA
Suffix:
Gender:F
Credentials:RSA
Other - Prefix:
Other - First Name:
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Other - Credentials:
Mailing Address - Street 1:24427 ARROWHEAD DR
Mailing Address - Street 2:
Mailing Address - City:MANHATTAN
Mailing Address - State:IL
Mailing Address - Zip Code:60442-1452
Mailing Address - Country:US
Mailing Address - Phone:815-278-2630
Mailing Address - Fax:815-478-3167
Practice Address - Street 1:24427 ARROWHEAD DR
Practice Address - Street 2:
Practice Address - City:MANHATTAN
Practice Address - State:IL
Practice Address - Zip Code:60442-1452
Practice Address - Country:US
Practice Address - Phone:815-278-2630
Practice Address - Fax:815-478-3167
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-15
Last Update Date:2013-12-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL238.000096363AS0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AS0400XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantSurgical
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL9932724OtherBCBS