Individual
SHANNON LIAT IRVING
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
460 RIDGECREST AVE, FAMILY INFANT TODDLER PROGRAM-SUITE 214, BETHEL, AK 99559-0281
(907) 543-1778
(907) 543-1276
Mailing address
PO BOX 281, BETHEL, AK 99559-0281
(907) 545-5716
Taxonomy
Speciality
Code
Description
License number
State
171M00000X
Case Manager/Care Coordinator
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
1002573
—
AK
Enumeration date
03/15/2012
Last updated
12/11/2013
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