Provider Demographics
NPI:1275034951
Name:CHYTHLOOK, HEATHER
Entity Type:Individual
Prefix:MS
First Name:HEATHER
Middle Name:
Last Name:CHYTHLOOK
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 73
Mailing Address - Street 2:
Mailing Address - City:ALEKNAGIK
Mailing Address - State:AK
Mailing Address - Zip Code:99555-0073
Mailing Address - Country:US
Mailing Address - Phone:907-842-5512
Mailing Address - Fax:
Practice Address - Street 1:123 MAIN ST
Practice Address - Street 2:
Practice Address - City:ALEKNAGIK
Practice Address - State:AK
Practice Address - Zip Code:99555-9800
Practice Address - Country:US
Practice Address - Phone:907-842-5512
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-02-27
Last Update Date:2018-02-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AK18-1498-I172V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes172V00000XOther Service ProvidersCommunity Health Worker