Provider Demographics
NPI:1194130567
Name:AXMANN, JENNIFER
Entity type:Individual
Prefix:
First Name:JENNIFER
Middle Name:
Last Name:AXMANN
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 1:700 KATLIAN ST
Mailing Address - Street 2:SUITE B
Mailing Address - City:SITKA
Mailing Address - State:AK
Mailing Address - Zip Code:99835-7359
Mailing Address - Country:US
Mailing Address - Phone:907-276-6960
Mailing Address - Fax:907-276-6961
Practice Address - Street 1:510 W 41ST AVE
Practice Address - Street 2:SUITE 101
Practice Address - City:ANCHORAGE
Practice Address - State:AK
Practice Address - Zip Code:99503-6646
Practice Address - Country:US
Practice Address - Phone:907-276-6960
Practice Address - Fax:907-279-6961
Is Sole Proprietor?:No
Enumeration Date:2014-06-24
Last Update Date:2014-06-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AK171M00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171M00000XOther Service ProvidersCase Manager/Care Coordinator