Individual
WILLIE JOHN
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Contact information
Practice address
185 HOFFMAN ROAD, BETHEL, AK 99559-0528
(907) 543-6741
(907) 543-4684
Mailing address
PO BOX 528, ATTN: BH PREVENTATIVE SERVICES, BETHEL, AK 99559-0528
(907) 543-6741
(907) 543-4684
Taxonomy
Speciality
Code
Description
License number
State
171M00000X
Case Manager/Care Coordinator
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
1020986
—
AK
Enumeration date
08/26/2015
Last updated
08/26/2015
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