Provider Demographics
NPI:1962825810
Name:MERCULIEF, JENNIFER
Entity Type:Individual
Prefix:
First Name:JENNIFER
Middle Name:
Last Name:MERCULIEF
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 1:934 MAIN STREET
Mailing Address - Street 2:
Mailing Address - City:ST. GEORGE
Mailing Address - State:AK
Mailing Address - Zip Code:99591
Mailing Address - Country:US
Mailing Address - Phone:907-859-2254
Mailing Address - Fax:907-859-2252
Practice Address - Street 1:1131 E INTERNATIONAL AIRPORT RD
Practice Address - Street 2:
Practice Address - City:ANCHORAGE
Practice Address - State:AK
Practice Address - Zip Code:99518-1408
Practice Address - Country:US
Practice Address - Phone:907-276-2700
Practice Address - Fax:907-279-4351
Is Sole Proprietor?:No
Enumeration Date:2014-01-29
Last Update Date:2014-01-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes172V00000XOther Service ProvidersCommunity Health Worker