Provider Demographics
NPI:1043601354
Name:BYBEE, AMANDA GRACE (CHA-III)
Entity Type:Individual
Prefix:
First Name:AMANDA
Middle Name:GRACE
Last Name:BYBEE
Suffix:
Gender:F
Credentials:CHA-III
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 263
Mailing Address - Street 2:
Mailing Address - City:MC GRATH
Mailing Address - State:AK
Mailing Address - Zip Code:99627-0263
Mailing Address - Country:US
Mailing Address - Phone:907-574-0348
Mailing Address - Fax:907-524-3805
Practice Address - Street 1:10 DNR RD.
Practice Address - Street 2:
Practice Address - City:MCGRATH
Practice Address - State:AK
Practice Address - Zip Code:99627-0010
Practice Address - Country:US
Practice Address - Phone:907-524-3299
Practice Address - Fax:907-524-3805
Is Sole Proprietor?:No
Enumeration Date:2015-02-09
Last Update Date:2015-02-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AK15-1340-III376K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes376K00000XNursing Service Related ProvidersNurse's Aide