Provider Demographics
NPI:1609422641
Name:MERCULIEF, JOSEPH J (CHA-I)
Entity Type:Individual
Prefix:
First Name:JOSEPH
Middle Name:J
Last Name:MERCULIEF
Suffix:
Gender:M
Credentials:CHA-I
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:P.O. BOX 94
Mailing Address - Street 2:
Mailing Address - City:SAINT MICHAEL
Mailing Address - State:AK
Mailing Address - Zip Code:99659-0094
Mailing Address - Country:US
Mailing Address - Phone:907-923-3311
Mailing Address - Fax:907-923-2287
Practice Address - Street 1:94 BAKER STREET
Practice Address - Street 2:
Practice Address - City:SAINT MICHAEL
Practice Address - State:AK
Practice Address - Zip Code:99659-0094
Practice Address - Country:US
Practice Address - Phone:907-923-3311
Practice Address - Fax:907-923-2287
Is Sole Proprietor?:Yes
Enumeration Date:2019-08-15
Last Update Date:2019-08-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AK172V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes172V00000XOther Service ProvidersCommunity Health Worker
Provider Identifiers
StateIdentifier IDID TypeIssuer
AKCHA-IOtherCHA-I