Provider Demographics
NPI:1316206576
Name:PETER, ETHEL BEVERLY
Entity Type:Individual
Prefix:MRS
First Name:ETHEL
Middle Name:BEVERLY
Last Name:PETER
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:100 SPRUCE STREET
Mailing Address - Street 2:
Mailing Address - City:FORT YUKON
Mailing Address - State:AK
Mailing Address - Zip Code:99740
Mailing Address - Country:US
Mailing Address - Phone:907-662-2460
Mailing Address - Fax:
Practice Address - Street 1:100 SPRUCE ST.
Practice Address - Street 2:
Practice Address - City:FORT YUKON
Practice Address - State:AK
Practice Address - Zip Code:99740
Practice Address - Country:US
Practice Address - Phone:907-662-2460
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2012-05-09
Last Update Date:2012-05-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes172V00000XOther Service ProvidersCommunity Health Worker