Provider Demographics
NPI:1982947248
Name:NILSSON, KRISTEN EILEEN
Entity Type:Individual
Prefix:MRS
First Name:KRISTEN
Middle Name:EILEEN
Last Name:NILSSON
Suffix:
Gender:F
Credentials:
Other - Prefix:MISS
Other - First Name:KRISTEN
Other - Middle Name:EILEEN
Other - Last Name:MERCHANT
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:3710 WOODLAND DR
Mailing Address - Street 2:SUITE 1100
Mailing Address - City:ANCHORAGE
Mailing Address - State:AK
Mailing Address - Zip Code:99517-2555
Mailing Address - Country:US
Mailing Address - Phone:907-677-6060
Mailing Address - Fax:907-644-1548
Practice Address - Street 1:3710 WOODLAND DR
Practice Address - Street 2:SUITE 1100
Practice Address - City:ANCHORAGE
Practice Address - State:AK
Practice Address - Zip Code:99517-2555
Practice Address - Country:US
Practice Address - Phone:907-677-6060
Practice Address - Fax:907-644-1548
Is Sole Proprietor?:Yes
Enumeration Date:2013-04-04
Last Update Date:2013-04-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AK171M00000X
251B00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251B00000XAgenciesCase Management
No171M00000XOther Service ProvidersCase Manager/Care Coordinator