Provider Demographics
NPI:1922540335
Name:BLILIE, HANNAH (EFDHA I)
Entity type:Individual
Prefix:
First Name:HANNAH
Middle Name:
Last Name:BLILIE
Suffix:
Gender:F
Credentials:EFDHA I
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:216 DALTON ST.
Mailing Address - Street 2:SUITE 102, BOX 1529
Mailing Address - City:HNS
Mailing Address - State:AK
Mailing Address - Zip Code:99827
Mailing Address - Country:US
Mailing Address - Phone:907-766-6372
Mailing Address - Fax:
Practice Address - Street 1:216 DALTON ST
Practice Address - Street 2:SUITE 102
Practice Address - City:HAINES
Practice Address - State:AK
Practice Address - Zip Code:99827
Practice Address - Country:US
Practice Address - Phone:907-766-6372
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2016-11-16
Last Update Date:2016-11-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AK16-138-EFDHA I172V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes172V00000XOther Service ProvidersCommunity Health Worker
Provider Identifiers
StateIdentifier IDID TypeIssuer
AK16-138-EFDHA IOtherCHAPCB