Healthcare Provider Details

I. General information

NPI: 1558683128
Provider Name (Legal Business Name): JENNIFER MARIE CORAK RN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: JENNIFER MARIE EKSTRAND

II. Dates (important events)

Enumeration Date: 02/23/2010
Last Update Date: 02/23/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

222 TONGASS DR
SITKA AK
99835-9416
US

IV. Provider business mailing address

105 JEFF DAVIS ST
SITKA AK
99835-7619
US

V. Phone/Fax

Practice location:
  • Phone: 907-966-8331
  • Fax:
Mailing address:
  • Phone: 907-747-4766
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163WX0003X
TaxonomyInpatient Obstetric Registered Nurse
License Number25117
License Number StateAK

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: