Provider Demographics
NPI:1396473666
Name:NIMMO, NATHAN
Entity type:Individual
Prefix:
First Name:NATHAN
Middle Name:
Last Name:NIMMO
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 1:4318 CHECKMATE DR APT 15
Mailing Address - Street 2:
Mailing Address - City:ANCHORAGE
Mailing Address - State:AK
Mailing Address - Zip Code:99508-5736
Mailing Address - Country:US
Mailing Address - Phone:907-841-0138
Mailing Address - Fax:
Practice Address - Street 1:1600 OMALLEY RD
Practice Address - Street 2:
Practice Address - City:ANCHORAGE
Practice Address - State:AK
Practice Address - Zip Code:99507-7301
Practice Address - Country:US
Practice Address - Phone:907-349-2222
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-08-12
Last Update Date:2022-08-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessionalGroup - Single Specialty