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General NPI Number Information
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NPI Number | 1346601457
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Entity Type | Organization
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Legal Business Name | STATE OF ALASKA PUBLIC HEALTH NURSING
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Dates
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Enumeration Date | 03/16/2016
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Last Update Date | 03/16/2016
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Provider Practice Location Address
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Address Line | 3054 FIFTH AVE
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City | KETCHIKAN
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State | AK
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Zip | 99901-5773
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Country | US
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Telephone | 907-225-4350
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Fax | 907-247-0978
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Provider Business Mailing Address
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Address Line | 14818 N TONGASS HWY
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City | KETCHIKAN
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State | AK
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Zip | 99901-8902
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Country | US
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Telephone | 907-225-4328
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Fax |
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Authorized Official
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Title or Position | NURSE MANAGER
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Name | MRS. SUSAN RENEE BERGMANN
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Credential | RN
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Telephone | 907-225-4350
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 251S00000X
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Taxonomy Name | Community/Behavioral Health Agency
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License Number | NURR8365
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License Number State | AK
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