Provider Demographics
NPI:1336340231
Name:HOBSON, IVETTE
Entity type:Individual
Prefix:
First Name:IVETTE
Middle Name:
Last Name:HOBSON
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:PO BOX 3745
Mailing Address - Street 2:
Mailing Address - City:KODIAK
Mailing Address - State:AK
Mailing Address - Zip Code:99615-3745
Mailing Address - Country:US
Mailing Address - Phone:907-486-8322
Mailing Address - Fax:
Practice Address - Street 1:1623 MILL BAY RD
Practice Address - Street 2:SUITE100
Practice Address - City:KODIAK
Practice Address - State:AK
Practice Address - Zip Code:99615-6235
Practice Address - Country:US
Practice Address - Phone:907-486-5011
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-29
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171M00000XOther Service ProvidersCase Manager/Care Coordinator
Provider Identifiers
StateIdentifier IDID TypeIssuer
AKCM8260Medicaid