Provider Demographics
NPI:1528584901
Name:FONTAINE, SARAH DIONNE
Entity Type:Individual
Prefix:MRS
First Name:SARAH
Middle Name:DIONNE
Last Name:FONTAINE
Suffix:
Gender:F
Credentials:
Other - Prefix:MISS
Other - First Name:SARAH
Other - Middle Name:DIONNE
Other - Last Name:KEOHANE
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:BA SOCIOLOGY
Mailing Address - Street 1:PO BOX 230995
Mailing Address - Street 2:
Mailing Address - City:ANCHORAGE
Mailing Address - State:AK
Mailing Address - Zip Code:99523-0995
Mailing Address - Country:US
Mailing Address - Phone:907-310-8584
Mailing Address - Fax:844-575-8311
Practice Address - Street 1:5901 E 6TH AVE
Practice Address - Street 2:
Practice Address - City:ANCHORAGE
Practice Address - State:AK
Practice Address - Zip Code:99504-4874
Practice Address - Country:US
Practice Address - Phone:907-770-0855
Practice Address - Fax:844-575-8311
Is Sole Proprietor?:No
Enumeration Date:2017-08-17
Last Update Date:2020-02-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171M00000XOther Service ProvidersCase Manager/Care Coordinator