MEDICARE: MS. NICOLETTE THUDE ANP

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	363LF0000X	Family Nurse Practitioner	AK429	AK

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	5502254	OTHER		AETNA
2	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1013901479
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MS. NICOLETTE THUDE ANP

Provider Business Mailing Address
First Line	:	1651 GEORGE BELL CIR
Second Line	:
City	:	ANCHORAGE
State	:	AK
Zip	:	99515-3955
Country	:	US
Telephone Number	:	907-345-7082
Fax Number	:

Provider Business Practice Location Address
First Line	:	1651 GEORGE BELL CIR
Second Line	:	STE 900
City	:	ANCHORAGE
State	:	AK
Zip	:	99515-3955
Country	:	US
Telephone Number	:	907-345-7082
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	08/31/2005
Last Update Date	:	01/08/2013

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