Provider Demographics
NPI:1922842418
Name:MBISE, AMANA (SOCIAL WORKER)
Entity type:Individual
Prefix:
First Name:AMANA
Middle Name:
Last Name:MBISE
Suffix:
Gender:M
Credentials:SOCIAL WORKER
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1577 C ST STE 201
Mailing Address - Street 2:
Mailing Address - City:ANCHORAGE
Mailing Address - State:AK
Mailing Address - Zip Code:99501-5164
Mailing Address - Country:US
Mailing Address - Phone:907-538-9958
Mailing Address - Fax:907-865-2433
Practice Address - Street 1:1577 C ST STE 201
Practice Address - Street 2:
Practice Address - City:ANCHORAGE
Practice Address - State:AK
Practice Address - Zip Code:99501-5164
Practice Address - Country:US
Practice Address - Phone:907-538-9958
Practice Address - Fax:907-865-2433
Is Sole Proprietor?:No
Enumeration Date:2024-06-20
Last Update Date:2024-06-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AK210462104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker