Provider Demographics
NPI:1013504018
Name:BRENTON, CARA LYN
Entity Type:Individual
Prefix:
First Name:CARA
Middle Name:LYN
Last Name:BRENTON
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 1:805 LINCOLN ST
Mailing Address - Street 2:
Mailing Address - City:SITKA
Mailing Address - State:AK
Mailing Address - Zip Code:99835-7651
Mailing Address - Country:US
Mailing Address - Phone:907-738-9939
Mailing Address - Fax:
Practice Address - Street 1:805 LINCOLN ST
Practice Address - Street 2:
Practice Address - City:SITKA
Practice Address - State:AK
Practice Address - Zip Code:99835-7651
Practice Address - Country:US
Practice Address - Phone:907-738-9939
Practice Address - Fax:907-747-3627
Is Sole Proprietor?:No
Enumeration Date:2020-12-23
Last Update Date:2023-02-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes172V00000XOther Service ProvidersCommunity Health Worker