Provider Demographics
NPI:1578924254
Name:EVANS, NICOLE PANIGEO (BSW)
Entity Type:Individual
Prefix:
First Name:NICOLE
Middle Name:PANIGEO
Last Name:EVANS
Suffix:
Gender:F
Credentials:BSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 69
Mailing Address - Street 2:
Mailing Address - City:BARROW
Mailing Address - State:AK
Mailing Address - Zip Code:99723-0069
Mailing Address - Country:US
Mailing Address - Phone:907-852-0288
Mailing Address - Fax:907-852-4229
Practice Address - Street 1:1402 NACHIK STREET
Practice Address - Street 2:
Practice Address - City:BARROW
Practice Address - State:AK
Practice Address - Zip Code:99723
Practice Address - Country:US
Practice Address - Phone:907-852-0288
Practice Address - Fax:907-852-4229
Is Sole Proprietor?:No
Enumeration Date:2016-03-09
Last Update Date:2016-03-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselor