Provider Demographics
NPI:1811136120
Name:HUNTER, HOLLY JEAN
Entity type:Individual
Prefix:
First Name:HOLLY
Middle Name:JEAN
Last Name:HUNTER
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 1:1116 MISSION RD
Mailing Address - Street 2:
Mailing Address - City:KODIAK
Mailing Address - State:AK
Mailing Address - Zip Code:99615-6540
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:914 E REZANOF DR
Practice Address - Street 2:LOWER LEVEL-UNIT BY W/D
Practice Address - City:KODIAK
Practice Address - State:AK
Practice Address - Zip Code:99615-6724
Practice Address - Country:US
Practice Address - Phone:907-942-1284
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2009-02-10
Last Update Date:2012-04-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171M00000XOther Service ProvidersCase Manager/Care Coordinator
Provider Identifiers
StateIdentifier IDID TypeIssuer
AKCMG225Medicaid