Provider Demographics
NPI:1962799601
Name:BABCOCK, BONITA JOYCE (CHA)
Entity type:Individual
Prefix:MRS
First Name:BONITA
Middle Name:JOYCE
Last Name:BABCOCK
Suffix:
Gender:F
Credentials:CHA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:100 SLOCUM DRIVE
Mailing Address - Street 2:
Mailing Address - City:KING COVE
Mailing Address - State:AK
Mailing Address - Zip Code:99612-0100
Mailing Address - Country:US
Mailing Address - Phone:907-497-2311
Mailing Address - Fax:907-497-2310
Practice Address - Street 1:3380 C ST
Practice Address - Street 2:SUITE 100
Practice Address - City:ANCHORAGE
Practice Address - State:AK
Practice Address - Zip Code:99503-3949
Practice Address - Country:US
Practice Address - Phone:907-277-1440
Practice Address - Fax:907-277-1436
Is Sole Proprietor?:No
Enumeration Date:2011-07-01
Last Update Date:2011-10-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes172V00000XOther Service ProvidersCommunity Health Worker