Provider Demographics
NPI:1215295985
Name:ALBERT, ANNA M JR
Entity type:Individual
Prefix:
First Name:ANNA
Middle Name:M
Last Name:ALBERT
Suffix:JR
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 1:01 WASHETERIA WAY
Mailing Address - Street 2:
Mailing Address - City:TUNUNAK
Mailing Address - State:AK
Mailing Address - Zip Code:99681
Mailing Address - Country:US
Mailing Address - Phone:907-652-6012
Mailing Address - Fax:907-543-6008
Practice Address - Street 1:01 WASHETERIA WAY
Practice Address - Street 2:
Practice Address - City:TUNUNAK
Practice Address - State:AK
Practice Address - Zip Code:99681
Practice Address - Country:US
Practice Address - Phone:907-652-6012
Practice Address - Fax:907-543-6008
Is Sole Proprietor?:No
Enumeration Date:2012-05-01
Last Update Date:2018-07-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes172V00000XOther Service ProvidersCommunity Health Worker
No101Y00000XBehavioral Health & Social Service ProvidersCounselor
Provider Identifiers
StateIdentifier IDID TypeIssuer
AKMH0150Medicaid