Provider Demographics
NPI:1407024987
Name:NELSON, NICOLE LENORE
Entity Type:Individual
Prefix:MS
First Name:NICOLE
Middle Name:LENORE
Last Name:NELSON
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:NICOLE
Other - Middle Name:LENORE
Other - Last Name:MAYDWELL
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:PO BOX 82074
Mailing Address - Street 2:
Mailing Address - City:FAIRBANKS
Mailing Address - State:AK
Mailing Address - Zip Code:99708-2074
Mailing Address - Country:US
Mailing Address - Phone:907-455-9737
Mailing Address - Fax:907-479-9737
Practice Address - Street 1:615 23RD AVE STE 200
Practice Address - Street 2:
Practice Address - City:FAIRBANKS
Practice Address - State:AK
Practice Address - Zip Code:99701-7041
Practice Address - Country:US
Practice Address - Phone:907-455-9737
Practice Address - Fax:907-479-9737
Is Sole Proprietor?:No
Enumeration Date:2008-02-18
Last Update Date:2014-04-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171M00000XOther Service ProvidersCase Manager/Care Coordinator