Provider Demographics
NPI:1124405048
Name:MISCH, NINA
Entity Type:Individual
Prefix:
First Name:NINA
Middle Name:
Last Name:MISCH
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:PO BOX 292
Mailing Address - Street 2:
Mailing Address - City:TRINIDAD
Mailing Address - State:CA
Mailing Address - Zip Code:95570-0292
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:830 BRET HART ALY
Practice Address - Street 2:
Practice Address - City:ARCATA
Practice Address - State:CA
Practice Address - Zip Code:95521-6244
Practice Address - Country:US
Practice Address - Phone:707-682-9345
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2015-04-29
Last Update Date:2023-04-12
Deactivation Date:2022-12-04
Deactivation Code:
Reactivation Date:2022-12-14
Provider Licenses
StateLicense IDTaxonomies
CA1109921041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical