Provider Demographics
NPI:1881128551
Name:NICOLAI, ELSIE
Entity type:Individual
Prefix:
First Name:ELSIE
Middle Name:
Last Name:NICOLAI
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:101 MAIN CARTER ROAD
Mailing Address - Street 2:
Mailing Address - City:QUINHAGAK
Mailing Address - State:AK
Mailing Address - Zip Code:99655
Mailing Address - Country:US
Mailing Address - Phone:907-556-8320
Mailing Address - Fax:907-556-8340
Practice Address - Street 1:101 MAIN CARTER ROAD
Practice Address - Street 2:
Practice Address - City:QUINHAGAK
Practice Address - State:AK
Practice Address - Zip Code:99655
Practice Address - Country:US
Practice Address - Phone:907-556-8320
Practice Address - Fax:907-556-8340
Is Sole Proprietor?:No
Enumeration Date:2017-04-19
Last Update Date:2017-04-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes172V00000XOther Service ProvidersCommunity Health Worker