Individual
DIANE NELSON
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
CHA
Contact information
Practice address
EAST 2ND AVE, RUTH QUAMIIGGAN HENERY MEMORIAL CLINIC, KOYUK, AK 99753-0070
(907) 963-3311
(907) 963-3610
Mailing address
PO BOX 70, KOYUK, AK 99753-0070
(907) 963-3311
(907) 963-3610
Taxonomy
Speciality
Code
Description
License number
State
172V00000X
Community Health Worker
Primary
—
AK
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
CHA
CHA
AK
Enumeration date
09/02/2016
Last updated
09/02/2016
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