Provider Demographics
NPI:1841783321
Name:LITTLEFISH, ALEXIE M
Entity Type:Individual
Prefix:
First Name:ALEXIE
Middle Name:M
Last Name:LITTLEFISH
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:CHURCH ROAD 01
Mailing Address - Street 2:
Mailing Address - City:LOWER KALSKAG
Mailing Address - State:AK
Mailing Address - Zip Code:99626
Mailing Address - Country:US
Mailing Address - Phone:907-471-2347
Mailing Address - Fax:907-471-2258
Practice Address - Street 1:CHURCH ROAD 01
Practice Address - Street 2:
Practice Address - City:LOWER KALSKAG
Practice Address - State:AK
Practice Address - Zip Code:99626
Practice Address - Country:US
Practice Address - Phone:907-471-2347
Practice Address - Fax:907-471-2258
Is Sole Proprietor?:No
Enumeration Date:2018-06-11
Last Update Date:2018-06-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AK172V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes172V00000XOther Service ProvidersCommunity Health Worker