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General NPI Number Information
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NPI Number | 1861358624
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Entity Type | Individual
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Provider Name | SHELBA NICHOLAS
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Gender | Female
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Dates
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Enumeration Date | 12/24/2025
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Last Update Date | 12/30/2025
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Provider Practice Location Address
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Address Line | 4000 OLD SEWARD HWY
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City | ANCHORAGE
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State | AK
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Zip | 99503-6068
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Country | US
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Telephone | 907-770-0862
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Fax | 844-845-1120
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Provider Business Mailing Address
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Address Line | 18627 MAN O WAR RD
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City | EAGLE RIVER
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State | AK
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Zip | 99577-8336
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Country | US
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Telephone | 907-229-4239
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 164W00000X
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Taxonomy Name | Licensed Practical Nurse
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License Number | NURP6717
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License Number State | AK
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