Provider Demographics
NPI:1922623412
Name:MCCORMICK, VIVIEN (CNA)
Entity Type:Individual
Prefix:MRS
First Name:VIVIEN
Middle Name:
Last Name:MCCORMICK
Suffix:
Gender:F
Credentials:CNA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3240 PENLAND PKWY SPC 211
Mailing Address - Street 2:
Mailing Address - City:ANCHORAGE
Mailing Address - State:AK
Mailing Address - Zip Code:99508-1913
Mailing Address - Country:US
Mailing Address - Phone:907-519-3964
Mailing Address - Fax:
Practice Address - Street 1:3240 PENLAND PKWY SPC 211
Practice Address - Street 2:
Practice Address - City:ANCHORAGE
Practice Address - State:AK
Practice Address - Zip Code:99508-1913
Practice Address - Country:US
Practice Address - Phone:907-519-3964
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-06-10
Last Update Date:2020-06-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AK131257374U00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
No374U00000XNursing Service Related ProvidersHome Health Aide