Individual
MARIAN MARIE PETLA
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
6000 KANAKANAK RD., DILLINGHAM, AK 99576-0130
(907) 842-5201
(907) 842-9250
Mailing address
P.O. BOX 130, DILLINGHAM, AK 99576-0130
(907) 842-5201
(907) 842-9250
Taxonomy
Speciality
Code
Description
License number
State
247200000X
Other Technician
Primary
11-065DHAT
AK
Other
Enumeration date
11/30/2011
Last updated
11/30/2011
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