Healthcare Provider Details

I. General information

NPI: 1649916313
Provider Name (Legal Business Name): KAREN ANN PHILEMONOFF
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/06/2022
Last Update Date: 05/06/2022
Certification Date: 04/21/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1000 POLOVINA TURNPIKE
ST PAUL AK
99660-0148
US

IV. Provider business mailing address

PO BOX 148
ST PAUL AK
99660-0148
US

V. Phone/Fax

Practice location:
  • Phone: 907-546-8300
  • Fax:
Mailing address:
  • Phone: 907-546-8300
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code172V00000X
TaxonomyCommunity Health Worker
License Number
License Number StateAK

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: