Provider Demographics
NPI:1558493866
Name:NEMIRE, MISTY BLUE (CNA)
Entity type:Individual
Prefix:
First Name:MISTY
Middle Name:BLUE
Last Name:NEMIRE
Suffix:
Gender:F
Credentials:CNA
Other - Prefix:
Other - First Name:MISTY
Other - Middle Name:BLUE
Other - Last Name:NEMIRE
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:CNA
Mailing Address - Street 1:2950 TONGASS AVE.
Mailing Address - Street 2:SUITE 403
Mailing Address - City:KETCHIKAN
Mailing Address - State:AK
Mailing Address - Zip Code:99901
Mailing Address - Country:US
Mailing Address - Phone:907-228-4902
Mailing Address - Fax:907-228-5256
Practice Address - Street 1:2950 TONGASS AVE.
Practice Address - Street 2:SUITE 403
Practice Address - City:KETCHIKAN
Practice Address - State:AK
Practice Address - Zip Code:99901
Practice Address - Country:US
Practice Address - Phone:907-228-4902
Practice Address - Fax:907-228-5256
Is Sole Proprietor?:No
Enumeration Date:2007-03-12
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AK7847376K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes376K00000XNursing Service Related ProvidersNurse's Aide
Provider Identifiers
StateIdentifier IDID TypeIssuer
AK7847OtherCERTIFIED NURSE AIDE