MEDICARE: MRS. CORABELLE ANN HEDRICK

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	343900000X	Non-emergency Medical Transport (VAN)	5417071	AK

General Provider Information

NPI Number	:	1700108222
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MRS. CORABELLE ANN HEDRICK

Provider Business Mailing Address
First Line	:	PO BOX 872784
Second Line	:
City	:	WASILLA
State	:	AK
Zip	:	99687-2784
Country	:	US
Telephone Number	:	907-357-7675
Fax Number	:	907-357-7676

Provider Business Practice Location Address
First Line	:	2901 SILVER WINGS CIRCLE
Second Line	:
City	:	WASILLA
State	:	AK
Zip	:	99654-0000
Country	:	US
Telephone Number	:	907-357-7675
Fax Number	:	907-357-7676

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

Provider Enumeration Date	:	02/25/2010
Last Update Date	:	02/25/2010

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