Provider Demographics
NPI:1861903445
Name:KANRILAK, SAMANTHA R
Entity type:Individual
Prefix:
First Name:SAMANTHA
Middle Name:R
Last Name:KANRILAK
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 1:101 WASHETERIA WAY
Mailing Address - Street 2:
Mailing Address - City:TUNUNAK
Mailing Address - State:AK
Mailing Address - Zip Code:99681
Mailing Address - Country:US
Mailing Address - Phone:907-652-6012
Mailing Address - Fax:907-652-6512
Practice Address - Street 1:101 WASHETERIA WAY
Practice Address - Street 2:
Practice Address - City:TUNUNAK
Practice Address - State:AK
Practice Address - Zip Code:99681
Practice Address - Country:US
Practice Address - Phone:907-652-6012
Practice Address - Fax:907-652-6512
Is Sole Proprietor?:No
Enumeration Date:2017-10-23
Last Update Date:2017-10-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes172V00000XOther Service ProvidersCommunity Health Worker