MEDICARE: STEPHANIE PERRY

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	172V00000X	Community Health Worker
2	171M00000X	Case Manager/Care Coordinator

General Provider Information

NPI Number	:	1477846764
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	STEPHANIE PERRY

Provider Business Mailing Address
First Line	:	PO BOX 2294
Second Line	:
City	:	SOLDOTNA
State	:	AK
Zip	:	99669-2294
Country	:	US
Telephone Number	:	907-690-4348
Fax Number	:

Provider Business Practice Location Address
First Line	:	32023 ECHO LAKE RD
Second Line	:
City	:	SOLDOTNA
State	:	AK
Zip	:	99669-9188
Country	:	US
Telephone Number	:	907-690-4348
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	05/19/2011
Last Update Date	:	09/10/2019

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Directions to “ STEPHANIE PERRY ” Practice Location

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