Provider Demographics
NPI:1275800153
Name:BUCK, RITA J (C H P)
Entity Type:Individual
Prefix:
First Name:RITA
Middle Name:J
Last Name:BUCK
Suffix:
Gender:F
Credentials:C H P
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1 SCOW JOHN RD
Mailing Address - Street 2:
Mailing Address - City:WHITE MOUNTAIN
Mailing Address - State:AK
Mailing Address - Zip Code:99784
Mailing Address - Country:US
Mailing Address - Phone:907-638-2082
Mailing Address - Fax:907-638-3961
Practice Address - Street 1:1 SCOW JOHN RD
Practice Address - Street 2:
Practice Address - City:WHITE MOUNTAIN
Practice Address - State:AK
Practice Address - Zip Code:99784
Practice Address - Country:US
Practice Address - Phone:907-638-2082
Practice Address - Fax:907-638-3961
Is Sole Proprietor?:No
Enumeration Date:2011-11-21
Last Update Date:2011-11-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AK98-107-P172V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes172V00000XOther Service ProvidersCommunity Health Worker
Provider Identifiers
StateIdentifier IDID TypeIssuer
AKHEALTH AIDEOther98-107-P