Provider Demographics
NPI:1093592792
Name:WEYIOUANNA, ANNIE M
Entity Type:Individual
Prefix:
First Name:ANNIE
Middle Name:M
Last Name:WEYIOUANNA
Suffix:
Gender:F
Credentials:
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 72085
Mailing Address - Street 2:
Mailing Address - City:SHISHMAREF
Mailing Address - State:AK
Mailing Address - Zip Code:99772-2085
Mailing Address - Country:US
Mailing Address - Phone:907-649-2150
Mailing Address - Fax:907-649-2155
Practice Address - Street 1:BAY VIEW #1
Practice Address - Street 2:
Practice Address - City:SHISHMAREF
Practice Address - State:AK
Practice Address - Zip Code:99772
Practice Address - Country:US
Practice Address - Phone:907-649-2150
Practice Address - Fax:907-649-2155
Is Sole Proprietor?:Yes
Enumeration Date:2023-09-14
Last Update Date:2023-09-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes172V00000XOther Service ProvidersCommunity Health Worker