MEDICARE: MRS. DARLENE L WORKMAN CDC 11

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	101YA0400X	Addiction (Substance Use Disorder) Counselor		AK

General Provider Information

NPI Number	:	1629066402
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MRS. DARLENE L WORKMAN CDC 11

Provider Business Mailing Address
First Line	:	1408 19TH AVE
Second Line	:	CHIEF ANDREW ISAAC HEALTH CENTER
City	:	FAIRBANKS
State	:	AK
Zip	:	99701-5903
Country	:	US
Telephone Number	:	907-459-3800
Fax Number	:	907-459-3810

Provider Business Practice Location Address
First Line	:	1408 19TH AVE
Second Line	:	CHIEF ANDREW ISAAC HEALTH CENTER
City	:	FAIRBANKS
State	:	AK
Zip	:	99701-5903
Country	:	US
Telephone Number	:	907-459-3800
Fax Number	:	907-459-3810

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

Provider Enumeration Date	:	10/06/2005
Last Update Date	:	07/08/2007

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