Provider Demographics
NPI:1114050267
Name:IVANOFF, ANNE MICHELE
Entity type:Individual
Prefix:
First Name:ANNE
Middle Name:MICHELE
Last Name:IVANOFF
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:324 HILLSIDE DR
Mailing Address - Street 2:PO BOX 324
Mailing Address - City:UNALAKLEET
Mailing Address - State:AK
Mailing Address - Zip Code:99684
Mailing Address - Country:US
Mailing Address - Phone:907-624-5220
Mailing Address - Fax:
Practice Address - Street 1:189 AIRPORT RD
Practice Address - Street 2:
Practice Address - City:UNALAKLEET
Practice Address - State:AK
Practice Address - Zip Code:99684
Practice Address - Country:US
Practice Address - Phone:907-624-5220
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-14
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AK15900163WC1500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WC1500XNursing Service ProvidersRegistered NurseCommunity Health