1346601457 NPI number — STATE OF ALASKA PUBLIC HEALTH NURSING

Table of content: (NPI 1346601457)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1346601457 NPI number — STATE OF ALASKA PUBLIC HEALTH NURSING

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
STATE OF ALASKA PUBLIC HEALTH NURSING
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
6
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:
1346601457
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
03/16/2016
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
14818 N TONGASS HWY
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
KETCHIKAN
Provider Business Mailing Address State Name:
AK
Provider Business Mailing Address Postal Code:
99901-8902
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
907-225-4328
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
3054 FIFTH AVE
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
KETCHIKAN
Provider Business Practice Location Address State Name:
AK
Provider Business Practice Location Address Postal Code:
99901-5773
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
907-225-4350
Provider Business Practice Location Address Fax Number:
907-247-0978
Provider Enumeration Date:
03/16/2016

Additional Information

Authorized Official

Authorized Official Last Name:
BERGMANN
Authorized Official First Name:
SUSAN
Authorized Official Middle Name:
RENEE
Authorized Official Title or Position:
NURSE MANAGER
Authorized Official Telephone Number:
907-225-4350

Provider Taxonomy Codes

  • Taxonomy code: 251S00000X , with the licence number:  NURR8365 , registered in the state of AK ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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





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