Provider Demographics
NPI:1003281866
Name:VICK, SABRINA MARIE BEIERLY (DHAT)
Entity Type:Individual
Prefix:
First Name:SABRINA
Middle Name:MARIE BEIERLY
Last Name:VICK
Suffix:
Gender:F
Credentials:DHAT
Other - Prefix:
Other - First Name:SABRINA
Other - Middle Name:MARIE BEIERLY
Other - Last Name:CHILTON
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:3100 CHANNEL DR STE 300
Mailing Address - Street 2:
Mailing Address - City:JUNEAU
Mailing Address - State:AK
Mailing Address - Zip Code:99801-7837
Mailing Address - Country:US
Mailing Address - Phone:907-463-4074
Mailing Address - Fax:907-463-1510
Practice Address - Street 1:3245 HOSPITAL DR
Practice Address - Street 2:
Practice Address - City:JUNEAU
Practice Address - State:AK
Practice Address - Zip Code:99801-7809
Practice Address - Country:US
Practice Address - Phone:907-463-4040
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2015-12-04
Last Update Date:2019-12-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AK15-131-DHAT125J00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes125J00000XDental ProvidersDental Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
AK15-131-DHATOtherCOMMUNITY HEALTH AIDE PROGRAM