Provider Demographics
NPI:1619189776
Name:DEMARCO, DONNA R (AAS-HIS-CEO)
Entity Type:Individual
Prefix:MRS
First Name:DONNA
Middle Name:R
Last Name:DEMARCO
Suffix:
Gender:F
Credentials:AAS-HIS-CEO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:510 W TUDOR RD STE 3
Mailing Address - Street 2:
Mailing Address - City:ANCHORAGE
Mailing Address - State:AK
Mailing Address - Zip Code:99503-6649
Mailing Address - Country:US
Mailing Address - Phone:907-644-6004
Mailing Address - Fax:907-644-4432
Practice Address - Street 1:510 W TUDOR RD STE 3
Practice Address - Street 2:
Practice Address - City:ANCHORAGE
Practice Address - State:AK
Practice Address - Zip Code:99503-6649
Practice Address - Country:US
Practice Address - Phone:907-644-6004
Practice Address - Fax:907-644-4432
Is Sole Proprietor?:No
Enumeration Date:2007-05-03
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AK73237700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes237700000XSpeech, Language and Hearing Service ProvidersHearing Instrument Specialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
AKHA3372Medicaid