Provider Demographics
NPI:1275916850
Name:OKLEASIK, JOLENE (CHA-T)
Entity Type:Individual
Prefix:
First Name:JOLENE
Middle Name:
Last Name:OKLEASIK
Suffix:
Gender:F
Credentials:CHA-T
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:545 TUNDRA STREET
Mailing Address - Street 2:
Mailing Address - City:TELLER
Mailing Address - State:AK
Mailing Address - Zip Code:99778
Mailing Address - Country:US
Mailing Address - Phone:907-642-3311
Mailing Address - Fax:907-642-2046
Practice Address - Street 1:545 TUNDRA STREET
Practice Address - Street 2:
Practice Address - City:TELLER
Practice Address - State:AK
Practice Address - Zip Code:99778
Practice Address - Country:US
Practice Address - Phone:907-642-3311
Practice Address - Fax:907-642-2046
Is Sole Proprietor?:No
Enumeration Date:2015-07-01
Last Update Date:2015-07-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AK172V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes172V00000XOther Service ProvidersCommunity Health Worker