Individual
LUCY MARY BLACK
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
AIRPORT ROAD, HOOPER BAY, AK 99604-0049
(907) 758-3500
(907) 758-3540
Mailing address
PO BOX 49, HOOPER BAY, AK 99604-0049
(907) 758-3500
(907) 758-3540
Taxonomy
Speciality
Code
Description
License number
State
101Y00000X
Counselor
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
1020986
—
AK
Enumeration date
08/08/2013
Last updated
12/26/2013
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