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General NPI Number Information
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NPI Number | 1871529628
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Entity Type | Organization
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Legal Business Name | YAKUTAT TRIBAL HEALTH BOARD
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Dates
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Enumeration Date | 06/23/2006
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Last Update Date | 06/30/2021
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Provider Practice Location Address
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Address Line | 115 AIRPORT RD
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City | YAKUTAT
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State | AK
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Zip | 99689
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Country | US
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Telephone | 907-784-3275
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Fax | 907-784-3263
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Provider Business Mailing Address
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Address Line | PO BOX 112
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City | YAKUTAT
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State | AK
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Zip | 99689-0112
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Country | US
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Telephone | 907-784-3275
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Fax | 907-784-3263
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Authorized Official
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Title or Position | FINANCE MANAGER
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Name | CATHY WASSILLIE
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Credential |
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Telephone | 907-784-3275
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 363A00000X
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Taxonomy Name | Physician Assistant
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License Number |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 363L00000X
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Taxonomy Name | Nurse Practitioner
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License Number |
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License Number State |
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Taxonomy #3
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Taxonomy Code | 261Q00000X
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Taxonomy Name | Clinic/Center
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License Number | 288254
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License Number State | AK
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