Provider Demographics
NPI:1891225702
Name:NICOLI, AGNES OLINGA
Entity Type:Individual
Prefix:
First Name:AGNES
Middle Name:OLINGA
Last Name:NICOLI
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 1:269 MORGANS ROAD
Mailing Address - Street 2:
Mailing Address - City:ANIAK
Mailing Address - State:AK
Mailing Address - Zip Code:99557-0269
Mailing Address - Country:US
Mailing Address - Phone:907-675-4687
Mailing Address - Fax:907-675-4687
Practice Address - Street 1:269 MORGANS ROAD
Practice Address - Street 2:
Practice Address - City:ANIAK
Practice Address - State:AK
Practice Address - Zip Code:99557-0269
Practice Address - Country:US
Practice Address - Phone:907-675-4687
Practice Address - Fax:907-675-4687
Is Sole Proprietor?:No
Enumeration Date:2017-06-13
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes172V00000XOther Service ProvidersCommunity Health Worker