Provider Demographics
NPI:1710194113
Name:MARENAH, COUMBA CEESAY (CARE COORDINATOR)
Entity Type:Individual
Prefix:MRS
First Name:COUMBA
Middle Name:CEESAY
Last Name:MARENAH
Suffix:
Gender:F
Credentials:CARE COORDINATOR
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:820 MEDFRA ST
Mailing Address - Street 2:APT # 1062
Mailing Address - City:ANCHORAGE
Mailing Address - State:AK
Mailing Address - Zip Code:99501-3929
Mailing Address - Country:US
Mailing Address - Phone:907-223-9254
Mailing Address - Fax:907-564-7429
Practice Address - Street 1:540 W INTL AIRPORT RD
Practice Address - Street 2:NETOWRK 6
Practice Address - City:ANCHORAGE
Practice Address - State:AK
Practice Address - Zip Code:99518-1105
Practice Address - Country:US
Practice Address - Phone:907-564-6833
Practice Address - Fax:907-564-7495
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-16
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171M00000XOther Service ProvidersCase Manager/Care Coordinator
Provider Identifiers
StateIdentifier IDID TypeIssuer
AKCM2175Medicaid