Provider Demographics
NPI:1548538226
Name:WASSILIE, ANN MARIE (PDHA I)
Entity type:Individual
Prefix:
First Name:ANN
Middle Name:MARIE
Last Name:WASSILIE
Suffix:
Gender:F
Credentials:PDHA I
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:829 CHIEF EDDIE HOFFMAN
Mailing Address - Street 2:
Mailing Address - City:BETHEL
Mailing Address - State:AK
Mailing Address - Zip Code:99559
Mailing Address - Country:US
Mailing Address - Phone:907-543-6000
Mailing Address - Fax:
Practice Address - Street 1:KASIGLUK CLINIC
Practice Address - Street 2:
Practice Address - City:KASIGLUK
Practice Address - State:AK
Practice Address - Zip Code:99609
Practice Address - Country:US
Practice Address - Phone:907-477-6211
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2011-12-08
Last Update Date:2012-01-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes247200000XTechnologists, Technicians & Other Technical Service ProvidersTechnician, Other