Provider Demographics
NPI:1376851261
Name:RUKOVISHNIKOFF, PAULINE
Entity Type:Individual
Prefix:
First Name:PAULINE
Middle Name:
Last Name:RUKOVISHNIKOFF
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 1:1131 E INTERNATIONAL AIRPORT RD
Mailing Address - Street 2:
Mailing Address - City:ANCHORAGE
Mailing Address - State:AK
Mailing Address - Zip Code:99518-1408
Mailing Address - Country:US
Mailing Address - Phone:907-276-2700
Mailing Address - Fax:907-222-4279
Practice Address - Street 1:1000 POLOVENIA TURNPIKE ROAD
Practice Address - Street 2:
Practice Address - City:ST. PAUL
Practice Address - State:AK
Practice Address - Zip Code:99660
Practice Address - Country:US
Practice Address - Phone:907-546-8300
Practice Address - Fax:907-546-8372
Is Sole Proprietor?:Yes
Enumeration Date:2010-09-14
Last Update Date:2010-09-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes172V00000XOther Service ProvidersCommunity Health Worker