Provider Demographics
NPI:1548522824
Name:GIVON, NIRA (LAC)
Entity type:Individual
Prefix:MS
First Name:NIRA
Middle Name:
Last Name:GIVON
Suffix:
Gender:F
Credentials:LAC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 1907
Mailing Address - Street 2:
Mailing Address - City:KODIAK
Mailing Address - State:AK
Mailing Address - Zip Code:99615-1907
Mailing Address - Country:US
Mailing Address - Phone:907-486-6707
Mailing Address - Fax:
Practice Address - Street 1:202 CENTER AVE STE 101
Practice Address - Street 2:
Practice Address - City:KODIAK
Practice Address - State:AK
Practice Address - Zip Code:99615-7306
Practice Address - Country:US
Practice Address - Phone:907-486-6707
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-06-12
Last Update Date:2012-06-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AK44171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist