Provider Demographics
NPI:1740086404
Name:HOWELL, NICOLE MARSADES
Entity type:Individual
Prefix:
First Name:NICOLE
Middle Name:MARSADES
Last Name:HOWELL
Suffix:
Gender:
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:935 W SARAHS WAY
Mailing Address - Street 2:
Mailing Address - City:WASILLA
Mailing Address - State:AK
Mailing Address - Zip Code:99654-2226
Mailing Address - Country:US
Mailing Address - Phone:505-870-7865
Mailing Address - Fax:
Practice Address - Street 1:3800 LAKE OTIS PKWY
Practice Address - Street 2:
Practice Address - City:ANCHORAGE
Practice Address - State:AK
Practice Address - Zip Code:99508-5237
Practice Address - Country:US
Practice Address - Phone:907-519-8049
Practice Address - Fax:907-782-4148
Is Sole Proprietor?:Yes
Enumeration Date:2025-02-24
Last Update Date:2025-02-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA66788225700000X
AK232236225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist