Healthcare Provider Details

I. General information

NPI: 1982259347
Provider Name (Legal Business Name): NAYAMI L LONG CHA-I
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/02/2019
Last Update Date: 08/02/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

94 BAKER STREET
ST.MICHAEL AK
99659-0094
US

IV. Provider business mailing address

P.O. BOX 94
ST.MICHAEL AK
99659-0094
US

V. Phone/Fax

Practice location:
  • Phone: 907-923-3311
  • Fax: 907-923-2287
Mailing address:
  • Phone: 907-923-3311
  • Fax: 907-923-2287

VI. Provider taxonomy

Scope of Practice (Provider specialty)

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

VII. Legacy identifiers

For crosswalk purposes, the following legacy (non-NPI) identifiers are available for this provider:

# 1
IdentifierCHA-I
Identifier TypeOTHER
Identifier StateAK
Identifier IssuerCHA-I

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: