Individual
MRS. LOTTIE V TICKETT I
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
80 BACK STREET, SHUNGNAK, AK 99773-0080
(907) 437-2138
(907) 437-2139
Mailing address
80 BACK STREET, SHUNGNAK, AK 99773-0080
(907) 437-2138
(907) 437-2139
Taxonomy
Speciality
Code
Description
License number
State
172V00000X
Community Health Worker
Primary
00-019-P
AK
Other
Enumeration date
11/28/2011
Last updated
11/28/2011
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