Provider Demographics
NPI:1891305488
Name:RUKOVISHNIKOFF, ALISHA LYNNE
Entity Type:Individual
Prefix:
First Name:ALISHA
Middle Name:LYNNE
Last Name:RUKOVISHNIKOFF
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 1:7749 CHERRYWOOD CIR
Mailing Address - Street 2:
Mailing Address - City:ANCHORAGE
Mailing Address - State:AK
Mailing Address - Zip Code:99507-2973
Mailing Address - Country:US
Mailing Address - Phone:907-570-2333
Mailing Address - Fax:
Practice Address - Street 1:7749 CHERRYWOOD CIR
Practice Address - Street 2:
Practice Address - City:ANCHORAGE
Practice Address - State:AK
Practice Address - Zip Code:99507-2973
Practice Address - Country:US
Practice Address - Phone:907-570-2333
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-08-07
Last Update Date:2024-01-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171M00000XOther Service ProvidersCase Manager/Care Coordinator