Provider Demographics
NPI:1619675287
Name:VOLLEMA, ELIZABETH JANE (COMMUNITY HEALTH AID)
Entity Type:Individual
Prefix:
First Name:ELIZABETH
Middle Name:JANE
Last Name:VOLLEMA
Suffix:
Gender:F
Credentials:COMMUNITY HEALTH AID
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 383
Mailing Address - Street 2:TAZLINA VILLAGE CLINIC
Mailing Address - City:GLENNALLEN
Mailing Address - State:AK
Mailing Address - Zip Code:99588-0383
Mailing Address - Country:US
Mailing Address - Phone:907-822-4385
Mailing Address - Fax:907-822-8804
Practice Address - Street 1:110.5 RICHARDSON HIGHWAY
Practice Address - Street 2:
Practice Address - City:GLENNALLEN
Practice Address - State:AK
Practice Address - Zip Code:99588
Practice Address - Country:US
Practice Address - Phone:907-822-4385
Practice Address - Fax:907-822-4384
Is Sole Proprietor?:No
Enumeration Date:2023-02-22
Last Update Date:2023-02-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes172V00000XOther Service ProvidersCommunity Health Worker