MEDICARE: CHELSEA STARR MALSTROM

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	172V00000X	Community Health Worker

General Provider Information

NPI Number	:	1366813420
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	CHELSEA STARR MALSTROM

Provider Business Mailing Address
First Line	:	PO BOX 47025
Second Line	:
City	:	PEDRO BAY
State	:	AK
Zip	:	99647-0025
Country	:	US
Telephone Number	:	907-850-2229
Fax Number	:	907-850-3000

Provider Business Practice Location Address
First Line	:	2516 MOUNTAIN CIRCLE
Second Line	:
City	:	PEDRO BAY
State	:	AK
Zip	:	99647
Country	:	US
Telephone Number	:	907-850-2229
Fax Number	:	907-850-3000

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	10/15/2015
Last Update Date	:	10/15/2015

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Directions to “ CHELSEA STARR MALSTROM ” Practice Location

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