Provider Demographics
NPI:1477915817
Name:AMAKTOOLIK, ALICE
Entity type:Individual
Prefix:
First Name:ALICE
Middle Name:
Last Name:AMAKTOOLIK
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 1:69 MOSES POINT ROAD
Mailing Address - Street 2:
Mailing Address - City:ELIM
Mailing Address - State:AK
Mailing Address - Zip Code:99739-0069
Mailing Address - Country:US
Mailing Address - Phone:907-890-3311
Mailing Address - Fax:907-890-2280
Practice Address - Street 1:69 MOSES POINT ROAD
Practice Address - Street 2:
Practice Address - City:ELIM
Practice Address - State:AK
Practice Address - Zip Code:99739-0069
Practice Address - Country:US
Practice Address - Phone:907-890-3311
Practice Address - Fax:907-890-2280
Is Sole Proprietor?:Yes
Enumeration Date:2016-03-24
Last Update Date:2016-03-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AK172V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes172V00000XOther Service ProvidersCommunity Health Worker
Provider Identifiers
StateIdentifier IDID TypeIssuer
AKCHAOtherCHA