Provider Demographics
NPI:1700108222
Name:HEDRICK, CORABELLE ANN
Entity type:Individual
Prefix:MRS
First Name:CORABELLE
Middle Name:ANN
Last Name:HEDRICK
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 872784
Mailing Address - Street 2:
Mailing Address - City:WASILLA
Mailing Address - State:AK
Mailing Address - Zip Code:99687-2784
Mailing Address - Country:US
Mailing Address - Phone:907-357-7675
Mailing Address - Fax:907-357-7676
Practice Address - Street 1:2901 SILVER WINGS CIRCLE
Practice Address - Street 2:
Practice Address - City:WASILLA
Practice Address - State:AK
Practice Address - Zip Code:99654-0000
Practice Address - Country:US
Practice Address - Phone:907-357-7675
Practice Address - Fax:907-357-7676
Is Sole Proprietor?:Yes
Enumeration Date:2010-02-25
Last Update Date:2010-02-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AK5417071343900000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes343900000XTransportation ServicesNon-emergency Medical Transport (VAN)