Individual
CHANNA LISA KOOZAATA
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
190 GRAVEL ROAD, GAMBELL, AK 99742-0190
(907) 985-5012
(907) 985-5085
Mailing address
190 GRAVEL ROAD, GAMBELL, AK 99742-0190
(907) 985-5012
(907) 985-5085
Taxonomy
Speciality
Code
Description
License number
State
172V00000X
Community Health Worker
Primary
10-1073-III
AK
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
10-1073-III
CHA III
AK
Enumeration date
03/21/2013
Last updated
03/21/2013
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