Provider Demographics
NPI:1205687787
Name:NANALOOK, MIKALA RENE
Entity type:Individual
Prefix:
First Name:MIKALA
Middle Name:RENE
Last Name:NANALOOK
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:PO BOX 129
Mailing Address - Street 2:
Mailing Address - City:MANOKOTAK
Mailing Address - State:AK
Mailing Address - Zip Code:99628-0129
Mailing Address - Country:US
Mailing Address - Phone:907-289-1077
Mailing Address - Fax:907-289-2014
Practice Address - Street 1:2ND STREET MANOKOTAK CLINIC
Practice Address - Street 2:
Practice Address - City:MANOKOTAK
Practice Address - State:AK
Practice Address - Zip Code:99628-0129
Practice Address - Country:US
Practice Address - Phone:907-289-1077
Practice Address - Fax:907-289-2014
Is Sole Proprietor?:No
Enumeration Date:2024-04-01
Last Update Date:2024-04-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AK24-1735--II172V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes172V00000XOther Service ProvidersCommunity Health Worker