Provider Demographics
NPI:1649916313
Name:PHILEMONOFF, KAREN ANN
Entity type:Individual
Prefix:
First Name:KAREN
Middle Name:ANN
Last Name:PHILEMONOFF
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:PO BOX 148
Mailing Address - Street 2:
Mailing Address - City:ST PAUL
Mailing Address - State:AK
Mailing Address - Zip Code:99660-0148
Mailing Address - Country:US
Mailing Address - Phone:907-546-8300
Mailing Address - Fax:
Practice Address - Street 1:1000 POLOVINA TURNPIKE
Practice Address - Street 2:
Practice Address - City:ST PAUL
Practice Address - State:AK
Practice Address - Zip Code:99660-0148
Practice Address - Country:US
Practice Address - Phone:907-546-8300
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-05-06
Last Update Date:2022-05-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AK172V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes172V00000XOther Service ProvidersCommunity Health Worker