Provider Demographics
NPI:1467121095
Name:VINCLER, MARIE LYDIA (CHAP)
Entity Type:Individual
Prefix:
First Name:MARIE
Middle Name:LYDIA
Last Name:VINCLER
Suffix:
Gender:F
Credentials:CHAP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3380 C ST STE 100
Mailing Address - Street 2:
Mailing Address - City:ANCHORAGE
Mailing Address - State:AK
Mailing Address - Zip Code:99503-3949
Mailing Address - Country:US
Mailing Address - Phone:907-277-1440
Mailing Address - Fax:907-277-1436
Practice Address - Street 1:113 MAIN STREET
Practice Address - Street 2:
Practice Address - City:AKUTAN
Practice Address - State:AK
Practice Address - Zip Code:99553
Practice Address - Country:US
Practice Address - Phone:907-698-2208
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-09-08
Last Update Date:2021-09-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AK172V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes172V00000XOther Service ProvidersCommunity Health Worker