Provider Demographics
NPI:1639672173
Name:TOMAGANUK-MOSES, TESSANNA N
Entity Type:Individual
Prefix:
First Name:TESSANNA
Middle Name:N
Last Name:TOMAGANUK-MOSES
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 1:101 AIRPORT ROAD
Mailing Address - Street 2:
Mailing Address - City:HOOPER BAY
Mailing Address - State:AK
Mailing Address - Zip Code:99604
Mailing Address - Country:US
Mailing Address - Phone:907-758-4711
Mailing Address - Fax:907-758-3540
Practice Address - Street 1:101 AIRPORT ROAD
Practice Address - Street 2:
Practice Address - City:HOOPER BAY
Practice Address - State:AK
Practice Address - Zip Code:99604
Practice Address - Country:US
Practice Address - Phone:907-758-4711
Practice Address - Fax:907-758-3540
Is Sole Proprietor?:No
Enumeration Date:2018-03-12
Last Update Date:2018-03-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes172V00000XOther Service ProvidersCommunity Health Worker