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DIANE NELSON CHA

>> Community Health Worker >> Other Service Providers

Registrant NPI Number: 1417404815

Individual Registrant:
 DIANE  NELSON CHA
Gender: F
Sole Proprietor

Location and contact information for practice:
EAST 2ND AVE RUTH QUAMIIGGAN HENERY MEMORIAL CLINIC KOYUK, AK 99753-0070 US
Tel: 907-963-3311  Fax: 907-963-3610

Contact information for business:
PO BOX 70  KOYUK, AK 99753-0070 US
Tel: 907-963-3311  Fax: 907-963-3610

Registration Information:
NPI: 1417404815
Entity Type: Individual

Specialty information:

PrimaryCodeCategory/DescriptionStateLicense Number
Y172V00000XOther Service Providers
Community Health Worker
AK

Legacy codes, insurance codes and state license numbers:

IssuerNumberStateType
CHACHAAK01




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