Individual
STACI SMART
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
700 CHIEF EDDIE HOFFMAN, BETHEL, AK 99559-0528
(907) 543-6100
(907) 543-6008
Mailing address
PO BOX 287, BETHEL, AK 99559-0287
(907) 543-6100
(907) 543-6008
Taxonomy
Speciality
Code
Description
License number
State
172V00000X
Community Health Worker
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
1020986
—
AK
Enumeration date
04/16/2014
Last updated
04/30/2020
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