Healthcare Provider Details

I. General information

NPI: 1932906617
Provider Name (Legal Business Name): CHARLOTTE N TIKIUN CHA
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/28/2025
Last Update Date: 02/28/2025
Certification Date: 02/25/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

700 CHIEF EDDIE HOFFMAN HWY
BETHEL AK
99559-3427
US

IV. Provider business mailing address

PO BOX 3427
BETHEL AK
99559-3427
US

V. Phone/Fax

Practice location:
  • Phone: 725-599-2183
  • Fax:
Mailing address:
  • Phone: 725-599-2183
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code172V00000X
TaxonomyCommunity Health Worker
License Number24-1764-I
License Number StateAK

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: