Provider Demographics
NPI:1609264639
Name:TOPKOK, NICOLE R
Entity Type:Individual
Prefix:
First Name:NICOLE
Middle Name:R
Last Name:TOPKOK
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 1:19 AIRPORT ROAD
Mailing Address - Street 2:
Mailing Address - City:TELLER
Mailing Address - State:AK
Mailing Address - Zip Code:99778
Mailing Address - Country:US
Mailing Address - Phone:907-642-3311
Mailing Address - Fax:907-642-2046
Practice Address - Street 1:19 AIRPORT ROAD
Practice Address - Street 2:
Practice Address - City:TELLER
Practice Address - State:AK
Practice Address - Zip Code:99778
Practice Address - Country:US
Practice Address - Phone:907-642-3311
Practice Address - Fax:907-642-2046
Is Sole Proprietor?:No
Enumeration Date:2014-12-29
Last Update Date:2014-12-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AKCHA II172V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes172V00000XOther Service ProvidersCommunity Health Worker
Provider Identifiers
StateIdentifier IDID TypeIssuer
AKCHA IIOtherCHA II