Individual
MR. ALONZO CRAIG LEISHOLMN SR.
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
CHA-IV
Contact information
Practice address
563 BRENDIBLE ST, METLAKATLA, AK 99926-0439
(907) 886-4741
(907) 886-5831
Mailing address
P.O. BOX 385, 1036 RAVEN ST, METLAKATLA, AK 99926-0385
(907) 617-5200
(907) 886-5831
Taxonomy
Speciality
Code
Description
License number
State
172V00000X
Community Health Worker
Primary
12-1169-IV
AK
Other
Enumeration date
03/15/2012
Last updated
08/22/2022
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