Healthcare Provider Details

I. General information

NPI: 1689048118
Provider Name (Legal Business Name): SUSAN STARR HIGLEY-BAILEY RN-BC, CCM
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 11/20/2015
Last Update Date: 11/24/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

100 SLOCUM DRIVE
KING COVE AK
99612-0009
US

IV. Provider business mailing address

3380 C ST
ANCHORAGE AK
99503-3949
US

V. Phone/Fax

Practice location:
  • Phone: 907-497-2311
  • Fax: 907-497-3190
Mailing address:
  • Phone: 907-277-1440
  • Fax: 907-277-1436

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163WC0400X
TaxonomyCase Management Registered Nurse
License Number35046
License Number StateAK

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: