Provider Demographics
NPI:1346601457
Name:STATE OF ALASKA PUBLIC HEALTH NURSING
Entity Type:Organization
Organization Name:STATE OF ALASKA PUBLIC HEALTH NURSING
Other - Org Name:STATE OF ALASKA
Other - Org Type:Other Name
Authorized Official - Title/Position:NURSE MANAGER
Authorized Official - Prefix:MRS
Authorized Official - First Name:SUSAN
Authorized Official - Middle Name:RENEE
Authorized Official - Last Name:BERGMANN
Authorized Official - Suffix:
Authorized Official - Credentials:RN
Authorized Official - Phone:907-225-4350
Mailing Address - Street 1:14818 N TONGASS HWY
Mailing Address - Street 2:
Mailing Address - City:KETCHIKAN
Mailing Address - State:AK
Mailing Address - Zip Code:99901-8902
Mailing Address - Country:US
Mailing Address - Phone:907-225-4328
Mailing Address - Fax:
Practice Address - Street 1:3054 FIFTH AVE
Practice Address - Street 2:
Practice Address - City:KETCHIKAN
Practice Address - State:AK
Practice Address - Zip Code:99901-5773
Practice Address - Country:US
Practice Address - Phone:907-225-4350
Practice Address - Fax:907-247-0978
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:STATE OF ALASKA
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2016-03-16
Last Update Date:2016-03-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AKNURR8365251S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health