Provider Demographics
NPI:1346599255
Name:ELEY, NICHOLETTE M
Entity Type:Individual
Prefix:
First Name:NICHOLETTE
Middle Name:M
Last Name:ELEY
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:NICHOLETTE
Other - Middle Name:M
Other - Last Name:GROSS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:LMT, CMLDT, E-RYT
Mailing Address - Street 1:188 W NORTHERN LIGHTS BLVD, SUITE 800
Mailing Address - Street 2:
Mailing Address - City:ANCHORAGE
Mailing Address - State:AK
Mailing Address - Zip Code:99503
Mailing Address - Country:US
Mailing Address - Phone:907-276-2803
Mailing Address - Fax:907-278-8052
Practice Address - Street 1:188 W NORTHERN LIGHTS BLVD, SUITE 800
Practice Address - Street 2:
Practice Address - City:ANCHORAGE
Practice Address - State:AK
Practice Address - Zip Code:99503
Practice Address - Country:US
Practice Address - Phone:907-276-2803
Practice Address - Fax:907-278-8052
Is Sole Proprietor?:No
Enumeration Date:2012-09-06
Last Update Date:2016-05-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AKMP2111174400000X
AK102001174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist