Provider Demographics
NPI:1083803928
Name:NDENDEROH, PETER K
Entity Type:Individual
Prefix:MR
First Name:PETER
Middle Name:K
Last Name:NDENDEROH
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5419 E 42ND AVE
Mailing Address - Street 2:
Mailing Address - City:ANCHORAGE
Mailing Address - State:AK
Mailing Address - Zip Code:99508-5711
Mailing Address - Country:US
Mailing Address - Phone:907-929-0448
Mailing Address - Fax:
Practice Address - Street 1:5419 E 42ND AVE
Practice Address - Street 2:
Practice Address - City:ANCHORAGE
Practice Address - State:AK
Practice Address - Zip Code:99508-5711
Practice Address - Country:US
Practice Address - Phone:907-929-0448
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-10-16
Last Update Date:2007-10-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251B00000XAgenciesCase Management