Provider Demographics
NPI:1851502751
Name:VASKA, SHARON TRISH
Entity Type:Individual
Prefix:MS
First Name:SHARON
Middle Name:TRISH
Last Name:VASKA
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 686
Mailing Address - Street 2:
Mailing Address - City:BETHEL
Mailing Address - State:AK
Mailing Address - Zip Code:99559-0686
Mailing Address - Country:US
Mailing Address - Phone:907-543-3161
Mailing Address - Fax:
Practice Address - Street 1:228 SWAN CT., BOX 686
Practice Address - Street 2:
Practice Address - City:BETHEL
Practice Address - State:AK
Practice Address - Zip Code:99559-0686
Practice Address - Country:US
Practice Address - Phone:907-543-3161
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-24
Last Update Date:2008-04-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AK296933251B00000X
AKXID19624367171M00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171M00000XOther Service ProvidersCase Manager/Care Coordinator
No251B00000XAgenciesCase Management
Provider Identifiers
StateIdentifier IDID TypeIssuer
AKCMG001Medicaid