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NPI Code Detail

MEDICARE: STEPHANIE PERRY

MEDICARE:   STEPHANIE  PERRY
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1172V00000XCommunity Health Worker
2171M00000XCase Manager/Care Coordinator

General Provider Information

NPI Number : 1477846764
Entity Type Code : Individual
Provider Name (Legal Business Name) : STEPHANIE PERRY
Provider Business Mailing Address
First Line : PO BOX 2294
Second Line :
City : SOLDOTNA
State : AK
Zip : 99669-2294
Country : US
Telephone Number : 907-690-4348
Fax Number :
Provider Business Practice Location Address
First Line : 32023 ECHO LAKE RD
Second Line :
City : SOLDOTNA
State : AK
Zip : 99669-9188
Country : US
Telephone Number : 907-690-4348
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 05/19/2011
Last Update Date : 09/10/2019

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Directions to “ STEPHANIE PERRY ” Practice Location

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