Provider Demographics
NPI:1881645059
Name:NIKKOLA, RACHAEL J (CRNA)
Entity Type:Individual
Prefix:MRS
First Name:RACHAEL
Middle Name:J
Last Name:NIKKOLA
Suffix:
Gender:F
Credentials:CRNA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:212 LAKEVIEW DR
Mailing Address - Street 2:
Mailing Address - City:SITKA
Mailing Address - State:AK
Mailing Address - Zip Code:99835-7308
Mailing Address - Country:US
Mailing Address - Phone:907-747-7187
Mailing Address - Fax:
Practice Address - Street 1:222 TONGASS DR
Practice Address - Street 2:
Practice Address - City:SITKA
Practice Address - State:AK
Practice Address - Zip Code:99835-9416
Practice Address - Country:US
Practice Address - Phone:907-966-8421
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-05-13
Last Update Date:2009-06-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI149952-030367500000X
AK306367500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367500000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Anesthetist, Certified Registered
Provider Identifiers
StateIdentifier IDID TypeIssuer
WI44341000Medicaid
AK8EE010OtherINDIVIDUAL PLAN
AKTE063OtherMEDICARE FACILITY PLAN
WI36045-0004Medicare ID - Type Unspecified