Healthcare Provider Details

I. General information

NPI: 1134308356
Provider Name (Legal Business Name): TANANA CHIEFS CONFERENCE
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/25/2007
Last Update Date: 04/25/2025
Certification Date: 04/25/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1408 19TH AVE
FAIRBANKS AK
99701-5903
US

IV. Provider business mailing address

1408 19TH AVE
FAIRBANKS AK
99701-5903
US

V. Phone/Fax

Practice location:
  • Phone: 907-451-6682
  • Fax: 907-459-3976
Mailing address:
  • Phone: 907-451-6682
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261Q00000X
TaxonomyClinic/Center
License Number17910
License Number StateAK

VIII. Authorized Official

Name: MRS. LIZA SARAH MALAMUTE
Title or Position: DIABETES EDUCATOR/FOOT CARE NURSE
Credential: RN, CDE, CFCN
Phone: 907-451-6682