Individual
IDA E LINCOLN
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
CHA III
Contact information
Practice address
1 SOW JOHN RD, WHITE MOUNTAIN, AK 99784-0029
(907) 638-3311
(907) 638-2007
Mailing address
P O BOX 29, 1 SOW JOHN RD, WHITE MOUNTAIN, AK 99784-0029
(907) 638-3311
(907) 638-2007
Taxonomy
Speciality
Code
Description
License number
State
172V00000X
Community Health Worker
Primary
11-1131-III
AK
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
HEALTH AIDE
111-1131-III
AK
Enumeration date
11/21/2011
Last updated
11/21/2011
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