Provider Demographics
NPI:1194866871
Name:AHTNA T' AENE NENE'
Entity Type:Organization
Organization Name:AHTNA T' AENE NENE'
Other - Org Name:COPPER RIVER NATIVE ASSOCIATION
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:907-822-8801
Practice Address - Street 1:MP 111.5 RICHARDSON HWY
Practice Address - Street 2:
Practice Address - City:COPPER CENTER
Practice Address - State:AK
Practice Address - Zip Code:99573-0508
Practice Address - Country:US
Practice Address - Phone:907-822-5241
Practice Address - Fax:907-822-8801
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-02-08
Last Update Date:2024-02-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AK36087101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental HealthGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
AKDA4434Medicaid
AKMH0641Medicaid