Individual
HARRY JONATHAN NICHOLAS JR.
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Contact information
Practice address
700 CHIEF EDDIE HOFFMAN HIGHWAY, BETHEL, AK 99559
(907) 543-6100
(907) 543-6159
Mailing address
PO BOX 287, BETHEL, AK 99559-0287
Taxonomy
Speciality
Code
Description
License number
State
171M00000X
Case Manager/Care Coordinator
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
1020986
—
AK
Enumeration date
11/08/2021
Last updated
11/08/2021
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