Provider Demographics
NPI:1538687512
Name:CARL, SAMUEL
Entity Type:Individual
Prefix:
First Name:SAMUEL
Middle Name:
Last Name:CARL
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:101 COUNCIL DRIVE
Mailing Address - Street 2:
Mailing Address - City:KIPNUK
Mailing Address - State:AK
Mailing Address - Zip Code:99614
Mailing Address - Country:US
Mailing Address - Phone:907-896-5334
Mailing Address - Fax:907-896-5537
Practice Address - Street 1:101 COUNCIL DRIVE
Practice Address - Street 2:
Practice Address - City:KIPNUK
Practice Address - State:AK
Practice Address - Zip Code:99614
Practice Address - Country:US
Practice Address - Phone:907-896-5334
Practice Address - Fax:907-896-5537
Is Sole Proprietor?:No
Enumeration Date:2017-08-30
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes172V00000XOther Service ProvidersCommunity Health Worker