Provider Demographics
NPI:1861005316
Name:VASICEK, CATHERINE JOANNA
Entity Type:Individual
Prefix:
First Name:CATHERINE
Middle Name:JOANNA
Last Name:VASICEK
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 1:44661 STERLING HWY STE A
Mailing Address - Street 2:
Mailing Address - City:SOLDOTNA
Mailing Address - State:AK
Mailing Address - Zip Code:99669-7900
Mailing Address - Country:US
Mailing Address - Phone:907-929-5826
Mailing Address - Fax:
Practice Address - Street 1:44661 STERLING HWY STE A
Practice Address - Street 2:
Practice Address - City:SOLDOTNA
Practice Address - State:AK
Practice Address - Zip Code:99669-7900
Practice Address - Country:US
Practice Address - Phone:907-929-5826
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-08-25
Last Update Date:2020-08-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AK3747P1801X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3747P1801XNursing Service Related ProvidersTechnicianPersonal Care Attendant
Provider Identifiers
StateIdentifier IDID TypeIssuer
AK1584304Medicaid