Provider Demographics
NPI:1659579886
Name:GINN, RACHEL ANN
Entity Type:Individual
Prefix:
First Name:RACHEL
Middle Name:ANN
Last Name:GINN
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 1:700 KATLIAN ST STE B
Mailing Address - Street 2:
Mailing Address - City:SITKA
Mailing Address - State:AK
Mailing Address - Zip Code:99835-7359
Mailing Address - Country:US
Mailing Address - Phone:907-747-6960
Mailing Address - Fax:907-747-4868
Practice Address - Street 1:700 KATLIAN ST STE B
Practice Address - Street 2:
Practice Address - City:SITKA
Practice Address - State:AK
Practice Address - Zip Code:99835-7359
Practice Address - Country:US
Practice Address - Phone:907-747-6960
Practice Address - Fax:907-747-4868
Is Sole Proprietor?:Yes
Enumeration Date:2007-07-10
Last Update Date:2007-07-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AKCM4196171M00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171M00000XOther Service ProvidersCase Manager/Care Coordinator
Provider Identifiers
StateIdentifier IDID TypeIssuer
AKCM4196MedicaidCARE COORDINATOR