Provider Demographics
NPI:1548300205
Name:RENK, NICHELLE COOK (MD)
Entity type:Individual
Prefix:DR
First Name:NICHELLE
Middle Name:COOK
Last Name:RENK
Suffix:
Gender:F
Credentials:MD
Other - Prefix:DR
Other - First Name:NICHELLE
Other - Middle Name:ANNE
Other - Last Name:COOK
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MD
Mailing Address - Street 1:2000 ABBOTT ROAD
Mailing Address - Street 2:UNIT A2
Mailing Address - City:ANCHORAGE
Mailing Address - State:AK
Mailing Address - Zip Code:99507-3878
Mailing Address - Country:US
Mailing Address - Phone:907-677-7246
Mailing Address - Fax:907-677-7245
Practice Address - Street 1:2000 ABBOTT RD STE A2
Practice Address - Street 2:
Practice Address - City:ANCHORAGE
Practice Address - State:AK
Practice Address - Zip Code:99507-3878
Practice Address - Country:US
Practice Address - Phone:907-677-7246
Practice Address - Fax:907-677-7245
Is Sole Proprietor?:Yes
Enumeration Date:2007-02-08
Last Update Date:2019-03-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AK7443207LP2900X, 208VP0000X, 207L00000X
CAA112891207LP2900X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208VP0000XAllopathic & Osteopathic PhysiciansPain MedicinePain Medicine
Yes207LP2900XAllopathic & Osteopathic PhysiciansAnesthesiologyPain MedicineGroup - Single Specialty
No207L00000XAllopathic & Osteopathic PhysiciansAnesthesiology