Provider Demographics
NPI:1568236610
Name:MULLIGAN-REAR, CHANTEL MARIE (CHA-1)
Entity Type:Individual
Prefix:
First Name:CHANTEL
Middle Name:MARIE
Last Name:MULLIGAN-REAR
Suffix:
Gender:F
Credentials:CHA-1
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 399
Mailing Address - Street 2:
Mailing Address - City:GUSTAVUS
Mailing Address - State:AK
Mailing Address - Zip Code:99826-0399
Mailing Address - Country:US
Mailing Address - Phone:907-697-3008
Mailing Address - Fax:907-697-3034
Practice Address - Street 1:28 STATE DOCK ROAD
Practice Address - Street 2:
Practice Address - City:GUSTVAUS
Practice Address - State:AK
Practice Address - Zip Code:99826
Practice Address - Country:US
Practice Address - Phone:907-697-3008
Practice Address - Fax:907-697-3034
Is Sole Proprietor?:No
Enumeration Date:2023-11-09
Last Update Date:2023-11-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AK23-1718-I172V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes172V00000XOther Service ProvidersCommunity Health Worker