Provider Demographics
NPI:1932536877
Name:DAVID, ALBERTA
Entity Type:Individual
Prefix:
First Name:ALBERTA
Middle Name:
Last Name:DAVID
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 1:123 TOK CUT OFF ROAD
Mailing Address - Street 2:
Mailing Address - City:TOK
Mailing Address - State:AK
Mailing Address - Zip Code:99780
Mailing Address - Country:US
Mailing Address - Phone:907-883-5185
Mailing Address - Fax:907-459-3925
Practice Address - Street 1:123 TOK CUT OFF ROAD
Practice Address - Street 2:
Practice Address - City:TOK
Practice Address - State:AK
Practice Address - Zip Code:99780
Practice Address - Country:US
Practice Address - Phone:907-883-5185
Practice Address - Fax:907-459-3925
Is Sole Proprietor?:No
Enumeration Date:2013-10-10
Last Update Date:2013-10-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes172V00000XOther Service ProvidersCommunity Health Worker