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General NPI Number Information
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NPI Number | 1134308356
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Entity Type | Organization
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Legal Business Name | TANANA CHIEFS CONFERENCE
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Dates
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Enumeration Date | 10/25/2007
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Last Update Date | 04/25/2025
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Provider Practice Location Address
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Address Line | 1408 19TH AVE
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City | FAIRBANKS
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State | AK
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Zip | 99701-5903
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Country | US
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Telephone | 907-451-6682
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Fax | 907-459-3976
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Provider Business Mailing Address
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Address Line | 1408 19TH AVE
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City | FAIRBANKS
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State | AK
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Zip | 99701-5903
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Country | US
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Telephone | 907-451-6682
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Fax |
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Authorized Official
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Title or Position | DIABETES EDUCATOR/FOOT CARE NURSE
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Name | MRS. LIZA SARAH MALAMUTE
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Credential | RN, CDE, CFCN
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Telephone | 907-451-6682
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261Q00000X
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Taxonomy Name | Clinic/Center
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License Number | 17910
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License Number State | AK
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