Individual
NICOLE RUTH OTTON
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
CHA-T
Contact information
Practice address
1000 GREG KRUSHEK AVE, NOME, AK 99762-9976
(907) 443-3311
(907) 443-3471
Mailing address
P.O. BOX 70, KOYUK, AK 99753
(907) 963-3311
(907) 963-3610
Taxonomy
Speciality
Code
Description
License number
State
172V00000X
Community Health Worker
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
CHA-T
CHA-T
AK
Enumeration date
08/30/2021
Last updated
08/30/2021
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