Provider Demographics
NPI:1932325354
Name:HOOSIER, MARIANNE (PA-C)
Entity Type:Individual
Prefix:
First Name:MARIANNE
Middle Name:
Last Name:HOOSIER
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
Other - First Name:MARIANNE
Other - Middle Name:
Other - Last Name:HOOSIER
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:PA-C
Mailing Address - Street 1:PO BOX 196105
Mailing Address - Street 2:CONOCO PHILLIPS-KUPARUK MEDICAL NSK-31
Mailing Address - City:ANCHORAGE
Mailing Address - State:AK
Mailing Address - Zip Code:99519-6105
Mailing Address - Country:US
Mailing Address - Phone:907-350-9195
Mailing Address - Fax:
Practice Address - Street 1:CONOCO PHILLIPS-KUPARUK MEDICAL
Practice Address - Street 2:NSK-31
Practice Address - City:ANCHORAGE
Practice Address - State:AK
Practice Address - Zip Code:99519
Practice Address - Country:US
Practice Address - Phone:907-350-9195
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-04-17
Last Update Date:2014-05-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AK497363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
AK1020401Medicaid
AKK165030Medicare PIN