Provider Demographics
NPI:1982912184
Name:NETTIES CARE COORDINATION
Entity Type:Organization
Organization Name:NETTIES CARE COORDINATION
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CARE COORDINATOR/OWNER
Authorized Official - Prefix:MS
Authorized Official - First Name:ANNETT
Authorized Official - Middle Name:LYNN
Authorized Official - Last Name:BROOKSHIRE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:907-776-5242
Mailing Address - Street 1:PO BOX 8526
Mailing Address - Street 2:
Mailing Address - City:NIKISKI
Mailing Address - State:AK
Mailing Address - Zip Code:99635-8526
Mailing Address - Country:US
Mailing Address - Phone:907-776-5242
Mailing Address - Fax:907-776-5227
Practice Address - Street 1:51768 STANGA STREET
Practice Address - Street 2:
Practice Address - City:NIKISKI
Practice Address - State:AK
Practice Address - Zip Code:99635-9513
Practice Address - Country:US
Practice Address - Phone:907-776-5242
Practice Address - Fax:907-776-5227
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-09-22
Last Update Date:2011-08-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AK946200251B00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251B00000XAgenciesCase Management