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RENEE M OLANNA CHA III
>> Community Health Worker >> Other Service ProvidersRegistrant NPI Number: 1619244340
Individual Registrant: RENEE M OLANNA CHA III
Gender: F
Not Sole Proprietor
Gender: F
Not Sole Proprietor
Location and contact information for practice:
85058 CLARENCE ROAD BREVIG MISSION, AK 99785-8505 US
Tel: 907-642-4311 Fax: 907-642-2216
Tel: 907-642-4311 Fax: 907-642-2216
Contact information for business:
85058 CLARENCE ROAD BOX 85058 BREVIG MISSION, AK 99785-8505 US
Tel: 907-642-4311 Fax: 907-642-2216
Tel: 907-642-4311 Fax: 907-642-2216
Registration Information:
NPI: 1619244340
Entity Type: Individual
Entity Type: Individual
Specialty information:
| Primary | Code | Category/Description | State | License Number |
|---|---|---|---|---|
| Y | 172V00000X | Other Service Providers Community Health Worker | AK | 11-1153-III |
Legacy codes, insurance codes and state license numbers:
| Issuer | Number | State | Type |
|---|---|---|---|
| 11-1153-III | CHA III | AK | 01 |
