Healthcare Provider Details

I. General information

NPI: 1467373464
Provider Name (Legal Business Name): NICOLE MARIE LEHAR RDH
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/24/2026
Last Update Date: 07/24/2026
Certification Date: 07/24/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1363 W SPRUCE AVE
WASILLA AK
99654-5327
US

IV. Provider business mailing address

19311 TRAIL BAY DR
EAGLE RIVER AK
99577-8833
US

V. Phone/Fax

Practice location:
  • Phone: 307-389-1284
  • Fax:
Mailing address:
  • Phone: 307-389-1284
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code124Q00000X
TaxonomyDental Hygienist
License Number002025239
License Number StateCO
# 2
Primary TaxonomyN
Taxonomy Code124Q00000X
TaxonomyDental Hygienist
License Number26160
License Number StateTX
# 3
Primary TaxonomyY
Taxonomy Code124Q00000X
TaxonomyDental Hygienist
License Number241191
License Number StateAK

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: