Provider Demographics
NPI:1932699519
Name:NICHOLAI, ELENA M
Entity Type:Individual
Prefix:
First Name:ELENA
Middle Name:M
Last Name:NICHOLAI
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 1:6044 BOARDWALK WAY
Mailing Address - Street 2:
Mailing Address - City:NAPASKIAK
Mailing Address - State:AK
Mailing Address - Zip Code:99559
Mailing Address - Country:US
Mailing Address - Phone:907-737-7329
Mailing Address - Fax:907-737-7435
Practice Address - Street 1:6044 BOARDWALK WAY
Practice Address - Street 2:
Practice Address - City:NAPASKIAK
Practice Address - State:AK
Practice Address - Zip Code:99559
Practice Address - Country:US
Practice Address - Phone:907-737-7329
Practice Address - Fax:907-737-7435
Is Sole Proprietor?:No
Enumeration Date:2018-05-18
Last Update Date:2018-05-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes172V00000XOther Service ProvidersCommunity Health Worker