Provider Demographics
NPI:1407283336
Name:KANGAS, MERRELINE
Entity Type:Individual
Prefix:
First Name:MERRELINE
Middle Name:
Last Name:KANGAS
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:PO BOX 68038
Mailing Address - Street 2:
Mailing Address - City:RUBY
Mailing Address - State:AK
Mailing Address - Zip Code:99768-0038
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:74 RUBY RD
Practice Address - Street 2:
Practice Address - City:RUBY
Practice Address - State:AK
Practice Address - Zip Code:99768
Practice Address - Country:US
Practice Address - Phone:907-452-8251
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2013-10-10
Last Update Date:2013-10-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes172V00000XOther Service ProvidersCommunity Health Worker