Provider Demographics
NPI:1609128859
Name:SIMPLE, MARGARET MARY
Entity Type:Individual
Prefix:
First Name:MARGARET
Middle Name:MARY
Last Name:SIMPLE
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 309
Mailing Address - Street 2:YUKON FLATS HEALTH CENTER
Mailing Address - City:FORT YUKON
Mailing Address - State:AK
Mailing Address - Zip Code:99740
Mailing Address - Country:US
Mailing Address - Phone:907-662-7565
Mailing Address - Fax:907-662-2709
Practice Address - Street 1:100 SPRUCE STREET
Practice Address - Street 2:YUKON FLATS HEALTH CENTER
Practice Address - City:FORT YUKON
Practice Address - State:AK
Practice Address - Zip Code:99740
Practice Address - Country:US
Practice Address - Phone:907-662-7565
Practice Address - Fax:907-662-2709
Is Sole Proprietor?:No
Enumeration Date:2012-10-12
Last Update Date:2012-10-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes172V00000XOther Service ProvidersCommunity Health Worker