Healthcare Provider Details

I. General information

NPI: 1275478976
Provider Name (Legal Business Name): MOLLY M NASSUK CHA-T
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/21/2026
Last Update Date: 04/21/2026
Certification Date: 04/15/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1000 GREG KRUSHEK AVE
NOME AK
99762-0966
US

IV. Provider business mailing address

1000 GREG KRUSHEK AVE
NOME AK
99762-0966
US

V. Phone/Fax

Practice location:
  • Phone: 907-443-3311
  • Fax: 907-443-3471
Mailing address:
  • Phone: 907-443-3311
  • Fax: 907-443-3471

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: