Healthcare Provider Details

I. General information

NPI: 1477416774
Provider Name (Legal Business Name): CAROL PAVIAN
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 12/04/2025
Last Update Date: 12/04/2025
Certification Date: 12/04/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

PO BOX 528 700 CHIEF EDDIE HOFFMAN HWY
BETHEL AK
99559-0528
US

IV. Provider business mailing address

PO BOX 528
BETHEL AK
99559-0528
US

V. Phone/Fax

Practice location:
  • Phone: 907-543-1782
  • Fax: 907-543-3152
Mailing address:
  • Phone: 907-543-1782
  • Fax: 907-543-3152

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code171M00000X
TaxonomyCase Manager/Care Coordinator
License Number
License Number StateAK

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: