Provider Demographics
NPI:1376199372
Name:ATSERIAK, CASEY J
Entity Type:Individual
Prefix:
First Name:CASEY
Middle Name:J
Last Name:ATSERIAK
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 1:194 2ND STREET
Mailing Address - Street 2:
Mailing Address - City:TULUKSAK
Mailing Address - State:AK
Mailing Address - Zip Code:99679
Mailing Address - Country:US
Mailing Address - Phone:907-695-6991
Mailing Address - Fax:907-695-6627
Practice Address - Street 1:194 2ND STREET
Practice Address - Street 2:
Practice Address - City:TULUKSAK
Practice Address - State:AK
Practice Address - Zip Code:99679
Practice Address - Country:US
Practice Address - Phone:907-695-6991
Practice Address - Fax:907-695-6627
Is Sole Proprietor?:No
Enumeration Date:2019-08-15
Last Update Date:2019-08-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes172V00000XOther Service ProvidersCommunity Health Worker