Provider Demographics
NPI:1043724511
Name:FLYGARE, ELISHA NICHOLE (CDC I, PSS I)
Entity Type:Individual
Prefix:
First Name:ELISHA
Middle Name:NICHOLE
Last Name:FLYGARE
Suffix:
Gender:F
Credentials:CDC I, PSS I
Other - Prefix:
Other - First Name:ELISHA
Other - Middle Name:NICHOLE
Other - Last Name:SALAZAR
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:CDC I, PSS I
Mailing Address - Street 1:8131 MEDELLIN CIR # A
Mailing Address - Street 2:
Mailing Address - City:ANCHORAGE
Mailing Address - State:AK
Mailing Address - Zip Code:99507-3270
Mailing Address - Country:US
Mailing Address - Phone:907-887-4405
Mailing Address - Fax:
Practice Address - Street 1:8131 MEDELLIN CIR # A
Practice Address - Street 2:
Practice Address - City:ANCHORAGE
Practice Address - State:AK
Practice Address - Zip Code:99507-3270
Practice Address - Country:US
Practice Address - Phone:907-887-4405
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2017-11-20
Last Update Date:2017-11-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AK101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)