Basic Information
| Provider Information | |||||||||
| NPI: | 1922540335 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | BLILIE | ||||||||
| FirstName: | HANNAH | ||||||||
| MiddleName: | |||||||||
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| Credential: | EFDHA I | ||||||||
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| Mailing Information | |||||||||
| Address1: | 216 DALTON ST. | ||||||||
| Address2: | SUITE 102, BOX 1529 | ||||||||
| City: | HNS | ||||||||
| State: | AK | ||||||||
| PostalCode: | 99827 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9077666372 | ||||||||
| FaxNumber: | |||||||||
| Practice Location | |||||||||
| Address1: | 216 DALTON ST | ||||||||
| Address2: | SUITE 102 | ||||||||
| City: | HAINES | ||||||||
| State: | AK | ||||||||
| PostalCode: | 99827 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9077666372 | ||||||||
| FaxNumber: | |||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 11/16/2016 | ||||||||
| LastUpdateDate: | 11/16/2016 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 172V00000X | 16-138-EFDHA I | AK | Y | Other Service Providers | Community Health Worker |
ID Information
| ID | Type | State | Issuer | Description | 16-138-EFDHA I | 01 | AK | CHAPCB | OTHER |