Provider Demographics
NPI:1578727764
Name:GAUTHIER, WILMA C
Entity Type:Individual
Prefix:
First Name:WILMA
Middle Name:C
Last Name:GAUTHIER
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 1:700 KATLIAN ST
Mailing Address - Street 2:SUITE B
Mailing Address - City:SITKA
Mailing Address - State:AK
Mailing Address - Zip Code:99835
Mailing Address - Country:US
Mailing Address - Phone:907-747-6960
Mailing Address - Fax:907-747-4868
Practice Address - Street 1:700 KATLIAN ST STE B
Practice Address - Street 2:
Practice Address - City:SITKA
Practice Address - State:AK
Practice Address - Zip Code:99835-7359
Practice Address - Country:US
Practice Address - Phone:907-747-6960
Practice Address - Fax:907-747-4868
Is Sole Proprietor?:Yes
Enumeration Date:2008-07-16
Last Update Date:2008-07-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171M00000XOther Service ProvidersCase Manager/Care Coordinator