Provider Demographics
NPI:1649821976
Name:CAPACITE, ATHENA MIKAILA
Entity type:Individual
Prefix:
First Name:ATHENA
Middle Name:MIKAILA
Last Name:CAPACITE
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 1:201 W CAROLINIAN CIR
Mailing Address - Street 2:
Mailing Address - City:NAGS HEAD
Mailing Address - State:NC
Mailing Address - Zip Code:27959-8707
Mailing Address - Country:US
Mailing Address - Phone:252-305-5677
Mailing Address - Fax:
Practice Address - Street 1:201 W CAROLINIAN CIR
Practice Address - Street 2:
Practice Address - City:NAGS HEAD
Practice Address - State:NC
Practice Address - Zip Code:27959-8707
Practice Address - Country:US
Practice Address - Phone:252-305-5677
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-09-27
Last Update Date:2019-09-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3747A0650XNursing Service Related ProvidersTechnicianAttendant Care Provider