Annelle Glee Maygren

 

NPI Number Detailed Information

Provider Information:

Name:	Annelle Glee Maygren
Gender:	F
Provider License Number If Given:	297

NPI Information:

NPI:	1477556488
Entity Type (Individual or Organization):	1-ind
Enumeration Date:	5/23/2005
Last Update Date:	1/18/2013

Provider Business Mailing Address:

Address:	PO BOX 89 Klawock, AK 99925
Phone Number:	9077554967
Fax Number:	9077552414

Provider Business Practice Location Address:

Address:	6488 KLAWOCK HOLLIS HWY #4 Klawock, AK 99925
Phone Number:	9077554967
Fax Number:	9077552414

Provider Taxonomy:

Primary:	152W00000X
Secondary (if any):	152W00000X
State:	AK