Provider Demographics
NPI:1396244893
Name:FLYGARE, EYDIE YVONNE (ADM, NCACI, CDCI)
Entity type:Individual
Prefix:
First Name:EYDIE
Middle Name:YVONNE
Last Name:FLYGARE
Suffix:
Gender:F
Credentials:ADM, NCACI, CDCI
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8131 MEDELLIN CIR UNIT A
Mailing Address - Street 2:
Mailing Address - City:ANCHORAGE
Mailing Address - State:AK
Mailing Address - Zip Code:99507-3270
Mailing Address - Country:US
Mailing Address - Phone:907-602-8644
Mailing Address - Fax:
Practice Address - Street 1:8131 MEDELLIN CIR UNIT A
Practice Address - Street 2:
Practice Address - City:ANCHORAGE
Practice Address - State:AK
Practice Address - Zip Code:99507-3270
Practice Address - Country:US
Practice Address - Phone:907-602-8644
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-02-09
Last Update Date:2018-02-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AK2933101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)
Provider Identifiers
StateIdentifier IDID TypeIssuer
AK2933Medicaid