Healthcare Provider Details

I. General information

NPI: 1831368661
Provider Name (Legal Business Name): TANANA CHIEFS CONFERENCE
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/26/2008
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

795 HIGH GRADE WAY
FAIRBANKS AK
99712-2015
US

V. Phone/Fax

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

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code313M00000X
TaxonomyNursing Facility/Intermediate Care Facility
License Number6352
License Number StateAK

VIII. Authorized Official

Name: ELIZABETH JEANNETTE WIEDMAIER
Title or Position: LICENSED PRACTICAL NURSE
Credential: LPN
Phone: 907-374-5086