Provider Demographics
NPI:1174053037
Name:STEVE, ROBIN MARY (CHA-T)
Entity type:Individual
Prefix:
First Name:ROBIN
Middle Name:MARY
Last Name:STEVE
Suffix:
Gender:F
Credentials:CHA-T
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:P.O. BOX 94
Mailing Address - Street 2:
Mailing Address - City:ST.MICHAEL
Mailing Address - State:AK
Mailing Address - Zip Code:99659-0094
Mailing Address - Country:US
Mailing Address - Phone:907-923-3311
Mailing Address - Fax:907-923-6068
Practice Address - Street 1:94 BAKER STREET
Practice Address - Street 2:
Practice Address - City:ST.MICHAEL
Practice Address - State:AK
Practice Address - Zip Code:99659-0094
Practice Address - Country:US
Practice Address - Phone:907-923-3311
Practice Address - Fax:907-923-6068
Is Sole Proprietor?:Yes
Enumeration Date:2017-06-14
Last Update Date:2017-06-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AK261QC1500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QC1500XAmbulatory Health Care FacilitiesClinic/CenterCommunity Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
AKCHA-TOtherCHA-T