Nicholette M Eley

Primary specialty

SpecialistTaxonomy code 174400000X

License

102001 Issued in AK

Practice address

188 W Northern Lights Blvd, Suite 800
Anchorage, AK 99503

Phone

(907) 276-2803

Fax

(907) 278-8052

NPI assigned

Sep 6, 2012

Sex

Female

Sole proprietor

No

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 2

Addresses

Other names 1

• Nicholette M Gross Former name

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

State licenses

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1346889600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1462838400000",
    "number": "1346599255",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "188 W NORTHERN LIGHTS BLVD, SUITE 800",
            "city": "ANCHORAGE",
            "state": "AK",
            "postal_code": "99503",
            "telephone_number": "907-276-2803",
            "fax_number": "907-278-8052"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "188 W NORTHERN LIGHTS BLVD, SUITE 800",
            "city": "ANCHORAGE",
            "state": "AK",
            "postal_code": "99503",
            "telephone_number": "907-276-2803",
            "fax_number": "907-278-8052"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "ELEY",
        "first_name": "NICHOLETTE",
        "middle_name": "M",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2012-09-06",
        "last_updated": "2016-05-10",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "174400000X",
            "taxonomy_group": "",
            "desc": "Specialist",
            "state": "AK",
            "license": "MP2111",
            "primary": false
        },
        {
            "code": "174400000X",
            "taxonomy_group": "",
            "desc": "Specialist",
            "state": "AK",
            "license": "102001",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "first_name": "NICHOLETTE",
            "last_name": "GROSS",
            "middle_name": "M",
            "credential": "LMT, CMLDT, E-RYT",
            "code": "1",
            "type": "Former Name"
        }
    ]
}

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• Specialist in Anchorage, AK
• Providers in Anchorage, AK by specialty
• Specialist in Alaska

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on May 10, 2016; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.