Provider Demographics
NPI:1740808419
Name:OKITKUN, WILONA L O
Entity type:Individual
Prefix:
First Name:WILONA
Middle Name:L O
Last Name:OKITKUN
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 1:35 MAIN STREET
Mailing Address - Street 2:
Mailing Address - City:KOTLIK
Mailing Address - State:AK
Mailing Address - Zip Code:99620
Mailing Address - Country:US
Mailing Address - Phone:907-899-4511
Mailing Address - Fax:907-899-4414
Practice Address - Street 1:35 MAIN STREET
Practice Address - Street 2:
Practice Address - City:KOTLIK
Practice Address - State:AK
Practice Address - Zip Code:99620
Practice Address - Country:US
Practice Address - Phone:907-899-4511
Practice Address - Fax:907-899-4414
Is Sole Proprietor?:No
Enumeration Date:2020-07-09
Last Update Date:2020-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes172V00000XOther Service ProvidersCommunity Health Worker