Provider Demographics
NPI:1164794954
Name:HOSKIE, ANDERSON
Entity Type:Individual
Prefix:
First Name:ANDERSON
Middle Name:
Last Name:HOSKIE
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:ANDERSON
Other - Middle Name:
Other - Last Name:HOSKIE
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:
Mailing Address - Street 1:PO BOX 1830
Mailing Address - Street 2:HWY 491 N. PINON ST.RED MODULAR BLDG
Mailing Address - City:SHIPROCK
Mailing Address - State:NM
Mailing Address - Zip Code:87420-1830
Mailing Address - Country:US
Mailing Address - Phone:505-368-1438
Mailing Address - Fax:505-368-1452
Practice Address - Street 1:HWY 491 N. PINON ST. RED MODULAR BLDG
Practice Address - Street 2:
Practice Address - City:SHIPROCK
Practice Address - State:NM
Practice Address - Zip Code:87420-1830
Practice Address - Country:US
Practice Address - Phone:505-368-1438
Practice Address - Fax:505-368-1452
Is Sole Proprietor?:No
Enumeration Date:2012-02-08
Last Update Date:2012-02-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171M00000XOther Service ProvidersCase Manager/Care Coordinator