MEDICARE: TESSANNA N JOE CHAIV

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	172V00000X	Community Health Worker

General Provider Information

NPI Number	:	1639672173
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	TESSANNA N JOE CHAIV

Provider Business Mailing Address
First Line	:	11 MAIN ST
Second Line	:
City	:	CLARKS POINT
State	:	AK
Zip	:	99569-9800
Country	:	US
Telephone Number	:	907-236-1232
Fax Number	:	907-842-9324

Provider Business Practice Location Address
First Line	:	11 MAIN ST
Second Line	:
City	:	CLARKS POINT
State	:	AK
Zip	:	99569-9800
Country	:	US
Telephone Number	:	907-236-1232
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	03/12/2018
Last Update Date	:	03/12/2026

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