Provider Demographics
NPI:1174556526
Name:AIKEN, MICHELE ROBIN (CRNP)
Entity type:Individual
Prefix:
First Name:MICHELE
Middle Name:ROBIN
Last Name:AIKEN
Suffix:
Gender:F
Credentials:CRNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1310 LINZ DR
Mailing Address - Street 2:
Mailing Address - City:FAIRBANKS
Mailing Address - State:AK
Mailing Address - Zip Code:99712-2762
Mailing Address - Country:US
Mailing Address - Phone:907-799-9150
Mailing Address - Fax:
Practice Address - Street 1:1867 AIRPORT WAY STE 140A
Practice Address - Street 2:
Practice Address - City:FAIRBANKS
Practice Address - State:AK
Practice Address - Zip Code:99701-4055
Practice Address - Country:US
Practice Address - Phone:907-457-9355
Practice Address - Fax:907-457-9356
Is Sole Proprietor?:No
Enumeration Date:2006-07-09
Last Update Date:2020-08-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AKNURU596363LF0000X
PASP011544363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
AKNP51361Medicaid
152942Medicare ID - Type Unspecified
AKNP51361Medicaid