Healthcare Provider Details

I. General information

NPI: 1215208897
Provider Name (Legal Business Name): BERTINA TIKIUN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/13/2012
Last Update Date: 01/13/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

829 CHIEF EDDIE HOFFMAN HIGHWAY
BETHEL AK
99559-0528
US

IV. Provider business mailing address

829 CHIEF EDDIE HOFFMAN HIGHWAY
BETHEL AK
99559-0528
US

V. Phone/Fax

Practice location:
  • Phone: 907-543-6160
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code172V00000X
TaxonomyCommunity Health Worker
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: