Provider Demographics
NPI:1710258645
Name:COGHILL, JOHANNA (CHA IV)
Entity Type:Individual
Prefix:
First Name:JOHANNA
Middle Name:
Last Name:COGHILL
Suffix:
Gender:F
Credentials:CHA IV
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:806 G ST.
Mailing Address - Street 2:
Mailing Address - City:NENANA
Mailing Address - State:AK
Mailing Address - Zip Code:99760
Mailing Address - Country:US
Mailing Address - Phone:907-832-5247
Mailing Address - Fax:
Practice Address - Street 1:806 G ST.
Practice Address - Street 2:
Practice Address - City:NENANA
Practice Address - State:AK
Practice Address - Zip Code:99760
Practice Address - Country:US
Practice Address - Phone:907-832-5247
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2012-01-24
Last Update Date:2012-01-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AK10-1083-IV172V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes172V00000XOther Service ProvidersCommunity Health Worker