Healthcare Provider Details

I. General information

NPI: 1982947248
Provider Name (Legal Business Name): MRS. KRISTEN EILEEN NILSSON
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

Provider Other Name: MISS KRISTEN EILEEN MERCHANT

II. Dates (important events)

Enumeration Date: 04/04/2013
Last Update Date: 04/05/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3710 WOODLAND DR SUITE 1100
ANCHORAGE AK
99517-2555
US

IV. Provider business mailing address

3710 WOODLAND DR SUITE 1100
ANCHORAGE AK
99517-2555
US

V. Phone/Fax

Practice location:
  • Phone: 907-677-6060
  • Fax: 907-644-1548
Mailing address:
  • Phone: 907-677-6060
  • Fax: 907-644-1548

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code251B00000X
TaxonomyCase Management Agency
License Number
License Number StateNULL
# 2
Primary TaxonomyN
Taxonomy Code171M00000X
TaxonomyCase Manager/Care Coordinator
License Number
License Number StateAK

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: