Provider Demographics
NPI:1487058152
Name:DEXTER, ELSIE MARY (HEALTH AIDE)
Entity type:Individual
Prefix:MRS
First Name:ELSIE
Middle Name:MARY
Last Name:DEXTER
Suffix:
Gender:F
Credentials:HEALTH AIDE
Other - Prefix:
Other - First Name:ELSIE
Other - Middle Name:MARY
Other - Last Name:DEXTER
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:COMMUNITY HEALTH AID
Mailing Address - Street 1:PO BOX 43
Mailing Address - Street 2:MANIILAQ HEALTH CENTER
Mailing Address - City:KOTZEBUE
Mailing Address - State:AK
Mailing Address - Zip Code:99752-0043
Mailing Address - Country:US
Mailing Address - Phone:907-442-3321
Mailing Address - Fax:907-442-7250
Practice Address - Street 1:436 5TH & TED STEVENS WAY
Practice Address - Street 2:MANIILAQ HEALTH CENTER
Practice Address - City:KOTZEBUE
Practice Address - State:AK
Practice Address - Zip Code:99752-0043
Practice Address - Country:US
Practice Address - Phone:907-442-3321
Practice Address - Fax:907-442-9205
Is Sole Proprietor?:No
Enumeration Date:2014-10-09
Last Update Date:2014-10-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes172V00000XOther Service ProvidersCommunity Health Worker