Charlie, Ida Shannon
Charlie, Ida Shannon is an individual health care provider with primary practice located at 829 Chief Eddie Hoffman Hwy Suite 150, Bethel AK 99559. She recently has only one registered license in Other Service Providers / Community Health Worker, which is considered as her primary health care specialty. Charlie, Ida Shannon can be contacted via phone (907) 543-6100.Contact Information
Primary practice address
829 Chief Eddie Hoffman Hwy Suite 150
Bethel AK 99559
Phone: (907) 543-6100
Fax: (907) 543-6159
Website:
Health care specialties
| Specialty | Code | License # | State |
|---|---|---|---|
| Other Service Providers / Community Health Worker | 172V00000X |
Profile Details
| NPI number | 1023222783 |
|---|---|
| LBN Legal business name | Charlie, Ida Shannon |
| Credentials | |
| Entity | Individual |
| Sole proprietor 1 | No |
| Enumeration date | May 10th, 2007 |
| Last updated | Jul 21st, 2022 - about 4 years ago |
1 A sole proprietor/sole proprietorship is an individual, and in that capacity, is qualified for a solitary NPI number. The sole proprietor have to apply for the NPI number using his or her own particular Social Security Number (SSN), instead of Employer Identification Number (EIN) regardless of whether he/she has an EIN.
Identifiers
| State | Type | Number | Issuer |
|---|---|---|---|
| All States | NPI | 1023222783 | NPPES |
| Alaska | MEDICAID | 1020986 |
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