Provider Demographics
NPI:1417393448
Name:NANSEN, IMELETA
Entity Type:Individual
Prefix:
First Name:IMELETA
Middle Name:
Last Name:NANSEN
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 1:1011 W 30TH AVE APT 3
Mailing Address - Street 2:
Mailing Address - City:ANCHORAGE
Mailing Address - State:AK
Mailing Address - Zip Code:99503-3704
Mailing Address - Country:US
Mailing Address - Phone:907-331-7683
Mailing Address - Fax:
Practice Address - Street 1:7821 ISLAND DR
Practice Address - Street 2:
Practice Address - City:ANCHORAGE
Practice Address - State:AK
Practice Address - Zip Code:99504-2728
Practice Address - Country:US
Practice Address - Phone:907-227-7081
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2013-05-16
Last Update Date:2013-05-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3747P1801XNursing Service Related ProvidersTechnicianPersonal Care Attendant