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Individual

NADINE ROSE CAPTAIN

Active
Sole proprietor
Yes

Provider details

NPI number
Gender
F

Contact information

Practice address
110 2ND AVE, FAIRBANKS, AK 99701-4809
(907) 452-7946
(907) 452-7942
Mailing address
4783 PRINCETON DR, FAIRBANKS, AK 99709-3216
(907) 978-7499

Taxonomy

Speciality
Code
Description
License number
State
101YM0800X
Mental Health Counselor
Primary

Other

Other identifiers
Code
Description
Identifier
Issuer
State
05
MH0157
AK
Enumeration date
02/07/2012
Last updated
02/20/2012
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