Provider Demographics
NPI:1023134392
Name:OCKWIG, MONICA (BA, CC)
Entity type:Individual
Prefix:MS
First Name:MONICA
Middle Name:
Last Name:OCKWIG
Suffix:
Gender:F
Credentials:BA, CC
Other - Prefix:
Other - First Name:MONICA
Other - Middle Name:
Other - Last Name:OCKWIG
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:BA CC
Mailing Address - Street 1:PO BOX 871282
Mailing Address - Street 2:
Mailing Address - City:WASILLA
Mailing Address - State:AK
Mailing Address - Zip Code:99687-1282
Mailing Address - Country:US
Mailing Address - Phone:907-892-5300
Mailing Address - Fax:907-892-5301
Practice Address - Street 1:49.9 PARKS HWY
Practice Address - Street 2:
Practice Address - City:WASILLA
Practice Address - State:AK
Practice Address - Zip Code:99654-1282
Practice Address - Country:US
Practice Address - Phone:907-892-5300
Practice Address - Fax:907-892-5301
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-21
Last Update Date:2009-10-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AK721672171M00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171M00000XOther Service ProvidersCase Manager/Care Coordinator
Provider Identifiers
StateIdentifier IDID TypeIssuer
AKCM12902Medicaid