Individual
ONI KITSUNE
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Contact information
Practice address
1515 E TUDOR RD STE 6, ANCHORAGE, AK 99507-1036
(907) 332-0065
(907) 782-4522
Mailing address
1515 E TUDOR RD STE 6, ANCHORAGE, AK 99507-1036
(907) 332-0065
(907) 782-4522
Taxonomy
Speciality
Code
Description
License number
State
171M00000X
Case Manager/Care Coordinator
Primary
DSDS
AK
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
DSDS
—
AK
Enumeration date
04/03/2019
Last updated
06/11/2019
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