Individual
STEPHANIE POULSEN
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
101 1ST AVE, TOGIAK, AK 99678
(907) 493-5511
(907) 493-5311
Mailing address
PO BOX 70, TOGIAK, AK 99678-0070
(907) 493-5511
(907) 493-5311
Taxonomy
Speciality
Code
Description
License number
State
172V00000X
Community Health Worker
Primary
17-1432-I
AK
Other
Enumeration date
04/18/2017
Last updated
04/18/2017
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