1710194113 NPI number — MRS. COUMBA CEESAY MARENAH CARE COORDINATOR

Table of content: MRS. COUMBA CEESAY MARENAH CARE COORDINATOR (NPI 1710194113)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1710194113 NPI number — MRS. COUMBA CEESAY MARENAH CARE COORDINATOR

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
MARENAH
Provider First Name:
COUMBA
Provider Middle Name:
CEESAY
Provider Name Prefix Text:
MRS.
Provider Name Suffix Text:
Provider Credential Text:
CARE COORDINATOR
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1710194113
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
07/09/2007
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
820 MEDFRA ST
Provider Second Line Business Mailing Address:
APT # 1062
Provider Business Mailing Address City Name:
ANCHORAGE
Provider Business Mailing Address State Name:
AK
Provider Business Mailing Address Postal Code:
99501-3929
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
907-223-9254
Provider Business Mailing Address Fax Number:
907-564-7429

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
540 W INTL AIRPORT RD
Provider Second Line Business Practice Location Address:
NETOWRK 6
Provider Business Practice Location Address City Name:
ANCHORAGE
Provider Business Practice Location Address State Name:
AK
Provider Business Practice Location Address Postal Code:
99518-1105
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
907-564-6833
Provider Business Practice Location Address Fax Number:
907-564-7495
Provider Enumeration Date:
05/16/2007

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 171M00000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: CM2175 , issued by the state of ( AK ) . This identifiers is of the category "MEDICAID".




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