Nicole Marie Alfonso
Individual provider Active NPI Massage Therapist · Palmer, AK
NPI 1700567898 · NPPES record last updated Jul 31, 2023
Key facts
- NPI
- 1700567898
- Entity type
- Individual (NPI type 1)
- Primary specialty
- Massage Therapist 225700000X
- License
- 210321 (AK)
- Practice address
- 550 S Alaska St Ste 104C
Palmer, AK 99645-6371 - Phone
- (907) 746-3270
- NPI assigned
- Jul 31, 2023
- Sex
- Female
- Sole proprietor
- Yes
Organizations & group practices 1
Medicare participation
- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
- Medicare enrollment (NPD)
- No
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 210321 | AK | MD | Massage Therapist |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Wild Iris Integrative Massage LLC | Massage Therapist | Past |
Accepting new patients |
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Massage Therapist | 225700000X | 210321 | AK | Yes |
Addresses
Primary practice location
550 S Alaska St Ste 104C
Palmer, AK 99645-6371
Mailing address
PO Box 3169
Palmer, AK 99645-3169
Phone (907) 351-4849
Other providers in Palmer, AK
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Jul 31, 2023. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.