1619675287 NPI number — ELIZABETH JANE VOLLEMA COMMUNITY HEALTH AID

Table of content: ELIZABETH JANE VOLLEMA COMMUNITY HEALTH AID (NPI 1619675287)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1619675287 NPI number — ELIZABETH JANE VOLLEMA COMMUNITY HEALTH AID

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
VOLLEMA
Provider First Name:
ELIZABETH
Provider Middle Name:
JANE
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
COMMUNITY HEALTH AID
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:
1619675287
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
02/22/2023
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 383
Provider Second Line Business Mailing Address:
TAZLINA VILLAGE CLINIC
Provider Business Mailing Address City Name:
GLENNALLEN
Provider Business Mailing Address State Name:
AK
Provider Business Mailing Address Postal Code:
99588-0383
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
907-822-4385
Provider Business Mailing Address Fax Number:
907-822-8804

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
110.5 RICHARDSON HIGHWAY
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
GLENNALLEN
Provider Business Practice Location Address State Name:
AK
Provider Business Practice Location Address Postal Code:
99588
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
907-822-4385
Provider Business Practice Location Address Fax Number:
907-822-4384
Provider Enumeration Date:
02/22/2023

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: 172V00000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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





Copyright © 2007-2025 www.npivalidator.com