Provider Demographics
NPI:1598044174
Name:WAUNEKA, PRISCILLA (EMT 1)
Entity Type:Individual
Prefix:MS
First Name:PRISCILLA
Middle Name:
Last Name:WAUNEKA
Suffix:
Gender:F
Credentials:EMT 1
Other - Prefix:
Other - First Name:PRISCILLA
Other - Middle Name:
Other - Last Name:MORRIS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:PO BOX 528
Mailing Address - Street 2:ATTN: BH SOBERING CENTER
Mailing Address - City:BETHEL
Mailing Address - State:AK
Mailing Address - Zip Code:99559-0528
Mailing Address - Country:US
Mailing Address - Phone:907-543-6830
Mailing Address - Fax:
Practice Address - Street 1:1360 CALISTA DR.
Practice Address - Street 2:BH SOBERING CENTER
Practice Address - City:BETHEL
Practice Address - State:AK
Practice Address - Zip Code:99559-0528
Practice Address - Country:US
Practice Address - Phone:907-545-6830
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2011-08-12
Last Update Date:2014-06-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
101Y00000X
AK13289003146M00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselor
No146M00000XEmergency Medical Service ProvidersEmergency Medical Technician, Intermediate
Provider Identifiers
StateIdentifier IDID TypeIssuer
AK1020986Medicaid