Provider Demographics
NPI:1255677506
Name:BLOCKER, EDWARD (CARE COORDINATOR)
Entity Type:Individual
Prefix:
First Name:EDWARD
Middle Name:
Last Name:BLOCKER
Suffix:
Gender:M
Credentials:CARE COORDINATOR
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6177 E MOUNTAIN HEATHER RD STE 5
Mailing Address - Street 2:
Mailing Address - City:PALMER
Mailing Address - State:AK
Mailing Address - Zip Code:99645-8442
Mailing Address - Country:US
Mailing Address - Phone:907-707-1087
Mailing Address - Fax:907-707-1013
Practice Address - Street 1:6177 E MOUNTAIN HEATHER RD STE 5
Practice Address - Street 2:
Practice Address - City:PALMER
Practice Address - State:AK
Practice Address - Zip Code:99645-8442
Practice Address - Country:US
Practice Address - Phone:907-707-1087
Practice Address - Fax:907-707-1013
Is Sole Proprietor?:No
Enumeration Date:2012-12-13
Last Update Date:2012-12-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AK171M00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171M00000XOther Service ProvidersCase Manager/Care Coordinator