Provider Demographics
NPI:1720347404
Name:SIMPSON, SONJA A (CHA III)
Entity Type:Individual
Prefix:
First Name:SONJA
Middle Name:A
Last Name:SIMPSON
Suffix:
Gender:F
Credentials:CHA III
Other - Prefix:
Other - First Name:SONJA
Other - Middle Name:A
Other - Last Name:BRADLEY
Other - Suffix:
Other - Last Name Type:Former Name
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
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
Practice Address - Country:US
Practice Address - Phone:907-890-3311
Practice Address - Fax:907-890-2280
Is Sole Proprietor?:No
Enumeration Date:2012-05-15
Last Update Date:2012-05-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AK09-1035-III172V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes172V00000XOther Service ProvidersCommunity Health Worker
Provider Identifiers
StateIdentifier IDID TypeIssuer
AK09-1035-IIIOtherCHA III