1841568862 NPI number — NIKKITTA ROSE ANGELIKA SMOKE CHA III

Table of content: NIKKITTA ROSE ANGELIKA SMOKE CHA III (NPI 1841568862)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1841568862 NPI number — NIKKITTA ROSE ANGELIKA SMOKE CHA III

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
SMOKE
Provider First Name:
NIKKITTA
Provider Middle Name:
ROSE ANGELIKA
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
CHA III
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1841568862
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
01/24/2018
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
201 1ST AVE,
Provider Second Line Business Mailing Address:
STE 300 COMMUNITY HEALTH AIDE PROGRAM
Provider Business Mailing Address City Name:
FAIRBANKS
Provider Business Mailing Address State Name:
AK
Provider Business Mailing Address Postal Code:
99701
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
907-452-8251
Provider Business Mailing Address Fax Number:
907-459-3978

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
201 1ST AVE,
Provider Second Line Business Practice Location Address:
STE 300 COMMUNITY HEALTH AIDE
Provider Business Practice Location Address City Name:
FAIRBANKS
Provider Business Practice Location Address State Name:
AK
Provider Business Practice Location Address Postal Code:
99701
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
907-452-8251
Provider Business Practice Location Address Fax Number:
907-459-3978
Provider Enumeration Date:
12/05/2011

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 172V00000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)





Copyright © 2007-2025 www.npivalidator.com