Provider Demographics
NPI:1659124782
Name:ELLER, SIERRA BROOKE
Entity Type:Individual
Prefix:
First Name:SIERRA
Middle Name:BROOKE
Last Name:ELLER
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 646
Mailing Address - Street 2:
Mailing Address - City:CRAIG
Mailing Address - State:AK
Mailing Address - Zip Code:99921-0646
Mailing Address - Country:US
Mailing Address - Phone:907-254-2904
Mailing Address - Fax:888-600-5292
Practice Address - Street 1:LOT 3 BLOCK 2
Practice Address - Street 2:
Practice Address - City:NAUKATI BAY
Practice Address - State:AK
Practice Address - Zip Code:99950
Practice Address - Country:US
Practice Address - Phone:907-254-2904
Practice Address - Fax:888-600-5292
Is Sole Proprietor?:Yes
Enumeration Date:2024-04-09
Last Update Date:2024-04-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171M00000XOther Service ProvidersCase Manager/Care Coordinator