Provider Demographics
NPI:1821232612
Name:BALES, JUANITA ANN
Entity Type:Individual
Prefix:MISS
First Name:JUANITA
Middle Name:ANN
Last Name:BALES
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 1:8023 MAIN STREET
Mailing Address - Street 2:
Mailing Address - City:NANWALEK
Mailing Address - State:AK
Mailing Address - Zip Code:99603
Mailing Address - Country:US
Mailing Address - Phone:907-281-2250
Mailing Address - Fax:907-281-2244
Practice Address - Street 1:8023 MAIN STREET
Practice Address - Street 2:
Practice Address - City:NANWALEK
Practice Address - State:AK
Practice Address - Zip Code:99603
Practice Address - Country:US
Practice Address - Phone:907-281-2250
Practice Address - Fax:907-281-2244
Is Sole Proprietor?:Yes
Enumeration Date:2009-04-24
Last Update Date:2023-05-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AK06-887-111172V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes172V00000XOther Service ProvidersCommunity Health Worker