Provider Demographics
NPI:1891454229
Name:BISWELL, COLSIE NICOLE (LMT)
Entity Type:Individual
Prefix:
First Name:COLSIE
Middle Name:NICOLE
Last Name:BISWELL
Suffix:
Gender:F
Credentials:LMT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:960 WICKERSHAM CIR
Mailing Address - Street 2:
Mailing Address - City:PALMER
Mailing Address - State:AK
Mailing Address - Zip Code:99645-7007
Mailing Address - Country:US
Mailing Address - Phone:907-414-4559
Mailing Address - Fax:
Practice Address - Street 1:960 WICKERSHAM CIR
Practice Address - Street 2:
Practice Address - City:PALMER
Practice Address - State:AK
Practice Address - Zip Code:99645-7007
Practice Address - Country:US
Practice Address - Phone:907-414-4559
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-12-13
Last Update Date:2021-12-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AK181446225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist