Basic Information
| Provider Information | |||||||||
| NPI: | 1700928272 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | NICHOLAS | ||||||||
| FirstName: | KATHERINE | ||||||||
| MiddleName: | BARRETT | ||||||||
| NamePrefix: | DR. | ||||||||
| NameSuffix: | |||||||||
| Credential: | MD | ||||||||
| OtherOrganizationName: | |||||||||
| OtherOrganizationType: | |||||||||
| OtherLastName: | MCNIFF | ||||||||
| OtherFirstName: | KATHERINE | ||||||||
| OtherMiddleName: | BARRETT | ||||||||
| OtherNamePrefix: | DR. | ||||||||
| OtherNameSuffix: | |||||||||
| OtherCredential: | MD | ||||||||
| OtherLastNameType: | 1 | ||||||||
| Mailing Information | |||||||||
| Address1: | 3300 PROVIDENCE DR | ||||||||
| Address2: | SUITE 207 | ||||||||
| City: | ANCHORAGE | ||||||||
| State: | AK | ||||||||
| PostalCode: | 995084690 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9072790555 | ||||||||
| FaxNumber: | |||||||||
| Practice Location | |||||||||
| Address1: | 3300 PROVIDENCE DR | ||||||||
| Address2: | SUITE 207 | ||||||||
| City: | ANCHORAGE | ||||||||
| State: | AK | ||||||||
| PostalCode: | 995084690 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9072790555 | ||||||||
| FaxNumber: | |||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 02/13/2007 | ||||||||
| LastUpdateDate: | 01/21/2014 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | Y | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 208D00000X | 0101237670 | VA | N | Allopathic & Osteopathic Physicians | General Practice | 208D00000X | MD441734 | PA | N | Allopathic & Osteopathic Physicians | General Practice | 207L00000X | 7782 | AK | Y | Allopathic & Osteopathic Physicians | Anesthesiology |
No ID Information.