Provider Demographics
NPI:1912453242
Name:RADTKE, NANCY (BHP)
Entity Type:Individual
Prefix:
First Name:NANCY
Middle Name:
Last Name:RADTKE
Suffix:
Gender:F
Credentials:BHP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:01 NIKLLIK STREET
Mailing Address - Street 2:
Mailing Address - City:NANWALEK
Mailing Address - State:AK
Mailing Address - Zip Code:99603-6649
Mailing Address - Country:US
Mailing Address - Phone:907-281-2247
Mailing Address - Fax:907-281-2244
Practice Address - Street 1:01 RED SALMON STREET
Practice Address - Street 2:
Practice Address - City:NANWALEK
Practice Address - State:AK
Practice Address - Zip Code:99603-6649
Practice Address - Country:US
Practice Address - Phone:907-281-2247
Practice Address - Fax:907-281-2244
Is Sole Proprietor?:Yes
Enumeration Date:2016-08-28
Last Update Date:2016-08-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AK12-082-BHP101Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselor