Individual
MICHELLE TOM
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
CHA-T
Contact information
Practice address
123 OCEANVIEW, STEBBINS, AK 99671
(907) 934-3311
(907) 934-3312
Mailing address
P.O. BOX 50, STEBBINS, AK 99671
(907) 934-3311
(907) 934-3312
Taxonomy
Speciality
Code
Description
License number
State
172V00000X
Community Health Worker
Primary
—
AK
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
CHA-T
CHA-T
AK
Enumeration date
06/26/2015
Last updated
06/26/2015
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