Provider Demographics
NPI:1770887820
Name:SCHWIERKING, STEFFANI RAE
Entity type:Individual
Prefix:
First Name:STEFFANI
Middle Name:RAE
Last Name:SCHWIERKING
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 1:176 POND REEF RD
Mailing Address - Street 2:
Mailing Address - City:KETCHIKAN
Mailing Address - State:AK
Mailing Address - Zip Code:99901-9308
Mailing Address - Country:US
Mailing Address - Phone:907-247-5027
Mailing Address - Fax:907-247-5028
Practice Address - Street 1:176 POND REEF RD
Practice Address - Street 2:
Practice Address - City:KETCHIKAN
Practice Address - State:AK
Practice Address - Zip Code:99901-9308
Practice Address - Country:US
Practice Address - Phone:907-247-5027
Practice Address - Fax:907-247-5028
Is Sole Proprietor?:No
Enumeration Date:2011-01-04
Last Update Date:2015-03-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171M00000XOther Service ProvidersCase Manager/Care Coordinator
Provider Identifiers
StateIdentifier IDID TypeIssuer
AK1620261Medicaid