Provider Demographics
NPI:1528528361
Name:MIKE, NICHOLAS (CHP)
Entity type:Individual
Prefix:
First Name:NICHOLAS
Middle Name:
Last Name:MIKE
Suffix:
Gender:M
Credentials:CHP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1008 AIRPORT RD
Mailing Address - Street 2:
Mailing Address - City:KOKHANOK
Mailing Address - State:AK
Mailing Address - Zip Code:99606-1008
Mailing Address - Country:US
Mailing Address - Phone:907-282-2203
Mailing Address - Fax:907-282-2240
Practice Address - Street 1:1008 AIRPORT RD
Practice Address - Street 2:
Practice Address - City:KOKHANOK
Practice Address - State:AK
Practice Address - Zip Code:99606
Practice Address - Country:US
Practice Address - Phone:907-282-2203
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-03-20
Last Update Date:2023-09-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AK376K00000X, 172V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes172V00000XOther Service ProvidersCommunity Health Worker
No376K00000XNursing Service Related ProvidersNurse's Aide