Provider Demographics
NPI:1225694326
Name:RYAN, NICOLE E (BA, CDCI)
Entity Type:Individual
Prefix:
First Name:NICOLE
Middle Name:E
Last Name:RYAN
Suffix:
Gender:F
Credentials:BA, CDCI
Other - Prefix:
Other - First Name:NICOLE
Other - Middle Name:EMILY
Other - Last Name:ATKINS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:BA, CDCI
Mailing Address - Street 1:4000 LAUREL ST
Mailing Address - Street 2:
Mailing Address - City:ANCHORAGE
Mailing Address - State:AK
Mailing Address - Zip Code:99508-5333
Mailing Address - Country:US
Mailing Address - Phone:907-729-6300
Mailing Address - Fax:907-729-6341
Practice Address - Street 1:4000 LAUREL ST
Practice Address - Street 2:
Practice Address - City:ANCHORAGE
Practice Address - State:AK
Practice Address - Zip Code:99508-5333
Practice Address - Country:US
Practice Address - Phone:907-729-6300
Practice Address - Fax:907-729-6341
Is Sole Proprietor?:Yes
Enumeration Date:2019-05-14
Last Update Date:2019-05-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AK4129101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)
Provider Identifiers
StateIdentifier IDID TypeIssuer
AK43762OtherBLUE CROSS