Provider Demographics
NPI:1679828016
Name:KOVAL, NANCY MATTIE
Entity Type:Individual
Prefix:
First Name:NANCY
Middle Name:MATTIE
Last Name:KOVAL
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 1:1632 N TRAIL CIR
Mailing Address - Street 2:
Mailing Address - City:WASILLA
Mailing Address - State:AK
Mailing Address - Zip Code:99654-5456
Mailing Address - Country:US
Mailing Address - Phone:907-357-2253
Mailing Address - Fax:907-745-5489
Practice Address - Street 1:1132 S CHUGACH ST
Practice Address - Street 2:
Practice Address - City:PALMER
Practice Address - State:AK
Practice Address - Zip Code:99645-6608
Practice Address - Country:US
Practice Address - Phone:907-745-5454
Practice Address - Fax:907-745-5489
Is Sole Proprietor?:No
Enumeration Date:2012-07-23
Last Update Date:2012-07-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171M00000XOther Service ProvidersCase Manager/Care Coordinator