Provider Demographics
NPI:1932594108
Name:BARR, BERTHA (CHA)
Entity Type:Individual
Prefix:
First Name:BERTHA
Middle Name:
Last Name:BARR
Suffix:
Gender:F
Credentials:CHA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:85058 CLARENCE RD
Mailing Address - Street 2:
Mailing Address - City:BREVIG MISSION
Mailing Address - State:AK
Mailing Address - Zip Code:99785
Mailing Address - Country:US
Mailing Address - Phone:907-642-4311
Mailing Address - Fax:907-642-2216
Practice Address - Street 1:85058 CLARENCE RD
Practice Address - Street 2:
Practice Address - City:BREVIG MISSION
Practice Address - State:AK
Practice Address - Zip Code:99785
Practice Address - Country:US
Practice Address - Phone:907-642-4311
Practice Address - Fax:907-642-2216
Is Sole Proprietor?:No
Enumeration Date:2015-04-03
Last Update Date:2015-04-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AK14-1291-II172V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes172V00000XOther Service ProvidersCommunity Health Worker
Provider Identifiers
StateIdentifier IDID TypeIssuer
AK141291-IIOtherCHA II