Healthcare Provider Details

I. General information

NPI: 1881645059
Provider Name (Legal Business Name): RACHAEL J NIKKOLA CRNA
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/13/2006
Last Update Date: 06/29/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

222 TONGASS DR
SITKA AK
99835-9416
US

IV. Provider business mailing address

212 LAKEVIEW DR
SITKA AK
99835-7308
US

V. Phone/Fax

Practice location:
  • Phone: 907-966-8421
  • Fax:
Mailing address:
  • Phone: 907-747-7187
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code367500000X
TaxonomyCertified Registered Nurse Anesthetist
License Number149952-030
License Number StateWI
# 2
Primary TaxonomyN
Taxonomy Code367500000X
TaxonomyCertified Registered Nurse Anesthetist
License Number306
License Number StateAK

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: