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Individual

NICOLE JUSTINE FLISS

Active
Sole proprietor
No

Provider details

NPI number
Gender
F
Credential
MD

Contact information

Practice address
1400 E 4TH AVE, ANCHORAGE, AK 99501-2857
(907) 269-4237
Mailing address
1830 EVANGELINE LN, ANCHORAGE, AK 99517-1395

Taxonomy

Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
Primary
4107
AK
207Q00000X
Family Medicine Physician
4301066122
MI

Other

Other identifiers
Code
Description
Identifier
Issuer
State
05
1346270865
MI
05
MD41072
AK
01
P00825315
MEDICARE RAILROAD
AK
Enumeration date
07/03/2006
Last updated
09/03/2021
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