Provider Demographics
NPI:1023389954
Name:ATKINSON, BRUCE (CHP)
Entity Type:Individual
Prefix:
First Name:BRUCE
Middle Name:
Last Name:ATKINSON
Suffix:
Gender:M
Credentials:CHP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:134 LONG LAKE RD.
Mailing Address - Street 2:
Mailing Address - City:EAGLE
Mailing Address - State:AK
Mailing Address - Zip Code:99738
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:134 LONG LAKE RD.
Practice Address - Street 2:
Practice Address - City:EAGLE
Practice Address - State:AK
Practice Address - Zip Code:99738
Practice Address - Country:US
Practice Address - Phone:907-547-2424
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2012-01-24
Last Update Date:2012-01-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AK99-202-P172V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes172V00000XOther Service ProvidersCommunity Health Worker