Provider Demographics
NPI:1073880704
Name:NAYOKPUK, THOMAS N (CHA IV)
Entity Type:Individual
Prefix:
First Name:THOMAS
Middle Name:N
Last Name:NAYOKPUK
Suffix:
Gender:M
Credentials:CHA IV
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:62039 DAGUMAAQ ROAD
Mailing Address - Street 2:BOX 62039
Mailing Address - City:GOLOVIN
Mailing Address - State:AK
Mailing Address - Zip Code:99762-6203
Mailing Address - Country:US
Mailing Address - Phone:907-779-3311
Mailing Address - Fax:907-779-3312
Practice Address - Street 1:62039 DAGUMAAQ ROAD
Practice Address - Street 2:
Practice Address - City:GOLOVIN
Practice Address - State:AK
Practice Address - Zip Code:99762-6203
Practice Address - Country:US
Practice Address - Phone:907-779-3311
Practice Address - Fax:907-779-3312
Is Sole Proprietor?:No
Enumeration Date:2011-11-23
Last Update Date:2011-11-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AK06-762-IV172V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes172V00000XOther Service ProvidersCommunity Health Worker
Provider Identifiers
StateIdentifier IDID TypeIssuer
AKCHA IVOther06-762-IV