Individual
NICOLE RENEE CARL
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
460 RIDGECREST DRIVE SUITE 215, BETHEL, AK 99559-0528
(907) 543-2762
(907) 543-3152
Mailing address
PO BOX 528, ATTN: BH DD SERVICES, BETHEL, AK 99559-0528
(907) 543-2762
(907) 543-3152
Taxonomy
Speciality
Code
Description
License number
State
171M00000X
Case Manager/Care Coordinator
Primary
—
—
373H00000X
Day Training/Habilitation Specialist
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
1002447
—
AK
05
—
1004541
—
AK
Enumeration date
06/13/2014
Last updated
06/13/2014
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