Provider Demographics
NPI:1164745691
Name:AHTNA T' AENE NENE'
Entity Type:Organization
Organization Name:AHTNA T' AENE NENE'
Other - Org Name:GULKANA CLINIC
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PATIENT FINANCIAL SERVICES MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:NIKKI
Authorized Official - Middle Name:R
Authorized Official - Last Name:WIEDLUND
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:907-206-6812
Mailing Address - Street 1:PO BOX 383
Mailing Address - Street 2:
Mailing Address - City:GLENNALLEN
Mailing Address - State:AK
Mailing Address - Zip Code:99588-0383
Mailing Address - Country:US
Mailing Address - Phone:907-822-5241
Mailing Address - Fax:907-822-8804
Practice Address - Street 1:MILE 111.5 RICHARDSON HWY
Practice Address - Street 2:
Practice Address - City:COPPER CENTER
Practice Address - State:AK
Practice Address - Zip Code:99573
Practice Address - Country:US
Practice Address - Phone:907-822-5241
Practice Address - Fax:907-822-8804
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-03-11
Last Update Date:2023-09-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AKS2312261QC1800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QC1800XAmbulatory Health Care FacilitiesClinic/CenterCorporate Health