Healthcare Provider Details

I. General information

NPI: 1619775186
Provider Name (Legal Business Name): JOLENE HUFFMAN RN-MSN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/03/2025
Last Update Date: 03/03/2025
Certification Date: 03/03/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

PO BOX 1145
KOTZEBUE AK
99752-1145
US

IV. Provider business mailing address

PO BOX 1145
KOTZEBUE AK
99752-1145
US

V. Phone/Fax

Practice location:
  • Phone: 575-590-0979
  • Fax:
Mailing address:
  • Phone: 575-590-0979
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License NumberRN-73193
License Number StateNM

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: