Provider Demographics
NPI:1689090227
Name:GOLOGERGEN, BRIANNE
Entity Type:Individual
Prefix:
First Name:BRIANNE
Middle Name:
Last Name:GOLOGERGEN
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 151
Mailing Address - Street 2:
Mailing Address - City:SAVOONGA
Mailing Address - State:AK
Mailing Address - Zip Code:99769
Mailing Address - Country:US
Mailing Address - Phone:907-984-6513
Mailing Address - Fax:907-984-6068
Practice Address - Street 1:FIRST BLUE BUILDING TO THE RIGHT WHEN LEAVE AIRPORT
Practice Address - Street 2:BOX 151
Practice Address - City:SAVOONGA
Practice Address - State:AK
Practice Address - Zip Code:99769
Practice Address - Country:US
Practice Address - Phone:907-984-6513
Practice Address - Fax:907-984-6068
Is Sole Proprietor?:No
Enumeration Date:2014-03-06
Last Update Date:2014-03-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AK121213III172V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes172V00000XOther Service ProvidersCommunity Health Worker
Provider Identifiers
StateIdentifier IDID TypeIssuer
AK12-1213-IIIOtherCHA III