Provider Demographics
NPI:1104193689
Name:GARFIELD, LORETTA PAULINE (CHP)
Entity Type:Individual
Prefix:
First Name:LORETTA
Middle Name:PAULINE
Last Name:GARFIELD
Suffix:
Gender:F
Credentials:CHP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:51003 MAIN STREET
Mailing Address - Street 2:BOX 3
Mailing Address - City:KOBUK
Mailing Address - State:AK
Mailing Address - Zip Code:99751-0003
Mailing Address - Country:US
Mailing Address - Phone:907-948-2218
Mailing Address - Fax:907-948-2199
Practice Address - Street 1:51003 MAIN STREET
Practice Address - Street 2:
Practice Address - City:KOBUK
Practice Address - State:AK
Practice Address - Zip Code:99751-0003
Practice Address - Country:US
Practice Address - Phone:907-948-2218
Practice Address - Fax:907-948-2199
Is Sole Proprietor?:No
Enumeration Date:2011-11-28
Last Update Date:2011-11-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AK08-975-P172V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes172V00000XOther Service ProvidersCommunity Health Worker